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Table 10: Evidence form HTA review : Breast cancer screening among women aged 40 – 49 Relative risks (intention to treat) with confidence reported for each study together with the results of a stepwise meta-analysis and cumulative CI Study ID Relative risk Confidence interval Cumulative RR Cumutlative CI UK Age Trial (UK) 0,83 (0,66-1,04) 0,83 (0,66-1,04) NBSS-1 (Canada) 0,97 (0,74-1,27) 0,89 (0,75-1,06) Malmö (Sweden) (0,58-1,77) 0,9 (0,76-1,06) Stockholm (Sweden) 1,08 (0,54-2,17) 0,91 (0,77-1,07) Göteborg (Sweden) 0,65 (0,40-1,05) 0,87 (0,75-1,02) HIP (USA) 0,75 (0,50-1,11) 0,86 (0,74-0,99) TCS (Sweden) 0,93 (0,63-1,36) 0,86 (0,75-0,99) Edinburgh (UK) 0,75 (0.48-1,18) 0,85 (0,75-0,97)
Table 8: Evidence form HTA review : Breast cancer screening among women aged 40 – 49 Relative risks (intention to treat) with confidence reported for each study together with the results of a stepwise meta-analysis and cumulative CI Study ID Relative risk Confidence interval Cumulative RR Cumutlative CI UK Age Trial (UK) 0,83 (0,66-1,04) 0,83 (0,66-1,04) NBSS-1 (Canada) 0,97 (0,74-1,27) 0,89 (0,75-1,06) Malmö (Sweden) (0,58-1,77) 0,9 (0,76-1,06) Stockholm (Sweden) 1,08 (0,54-2,17) 0,91 (0,77-1,07) Göteborg (Sweden) 0,65 (0,40-1,05) 0,87 (0,75-1,02) HIP (USA) 0,75 (0,50-1,11) 0,86 (0,74-0,99) TCS (Sweden) 0,93 (0,63-1,36) 0,86 (0,75-0,99) Edinburgh (UK) 0,75 (0.48-1,18) 0,85 (0,75-0,97)

Table 11: Evidence form HTA review : Breast cancer screening among women aged 40 – 49 Crude RR and and RR adjusted following Cuzick (1997) 22 Study ID study
Table 9: Evidence form HTA review : Breast cancer screening among women aged 40 – 49 Crude RR and and RR adjusted following Cuzick (1997) 21 Study ID study

Table 4: Search for additional RCTs Search Benefit and harms of mammography screening (40-49 y) questions Note Specific search for RCT’s Date 27/04/2010 Keywords Breast neoplasms (MESH), mass screening (or early detection) (MESH), mammography (MESH) Medline 1 Randomized controlled trials/ (66083) Medline (OVID): (OVID): 2 Randomized controlled trial.pt (289038) Filter Filter 3 Random allocation/ (67885) RCT RCT 4 Double blind method/ (105956) 5 Single blind method/ (13834) 6 Clinical trial.pt (460563) 7 exp clinical trial/ (606505) 8 or/1-7 (718664) 9 (clinic$ adj trial$).tw (146686) 10 ((singl$ or doubl$ or treb$ or tripl$) adj (blind$3 or mask$3)).tw (105209) 11 Placebos/ (28712) 12 Placebo$.tw (125428) 13 Randomly allocated.tw (12231) 14 (allocated adj2 random).tw (654) 15 9 or 10 or 11 or 12 or 13 or 14 (312732) 16 8 or 15 (842155) 17 Case report.tw (155883) 18 Letter.pt (688664) 19 Historical article.pt (263287) 20 Review of reported cases.pt (0) 21 Review,multicase.pt (0) 22 17 or 18 or 19 or 20 or 21 (1098644) 23 16 not 22 (822810) 24 Breast/ or Breast Diseases/ (30717) 25 Neoplasms/ (216644) 26 24 and 25 (535) 27 (breast$ adj5 neoplasm$).tw (1588) 28 (breast$ adj5 cancer$).tw (135654) 29 (breast$ adj5 carcin$).tw (31778) 30 (breast$ adj5 tumo$).tw (23438) 31 (breast$ adj5 metasta$).tw (16580) 32 (breast$ adj5 malig$).tw (7361) 33 exp Breast Neoplasms/ (171606) 34 exp Carcinoma, Ductal, Breast/ (8460) 35 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 (207174) 36 mammography.mp (23598) 37 screening.mp (274211) 38 36 or 37 (288429) 39 23 and 35 and 38 (2326) 40 limit 39 to (yr=" 2008 -Current" and " all adult (19 plus years)" and (dutch or english or french)) (241) 41 from 40 keep 1-241 (241) 42 from 41 keep 1-241 (241) CENTRAL Breast neoplasms (MESH) and early detection (MESH) or 61 mammography (MESH) (manual limit 2008-2010) in title , abstracts or key words
Table 2: Search for additional RCTs Search Benefit and harms of mammography screening (40-49 y) questions Note Specific search for RCT’s Date 27/04/2010 Keywords Breast neoplasms (MESH), mass screening (or early detection) (MESH), mammography (MESH) Medline 1 Randomized controlled trials/ (66083) Medline (OVID): (OVID): 2 Randomized controlled trial.pt (289038) Filter Filter 3 Random allocation/ (67885) RCT RCT 4 Double blind method/ (105956) 5 Single blind method/ (13834) 6 Clinical trial.pt (460563) 7 exp clinical trial/ (606505) 8 or/1-7 (718664) 9 (clinic$ adj trial$).tw (146686) 10 ((singl$ or doubl$ or treb$ or tripl$) adj (blind$3 or mask$3)).tw (105209) 11 Placebos/ (28712) 12 Placebo$.tw (125428) 13 Randomly allocated.tw (12231) 14 (allocated adj2 random).tw (654) 15 9 or 10 or 11 or 12 or 13 or 14 (312732) 16 8 or 15 (842155) 17 Case report.tw (155883) 18 Letter.pt (688664) 19 Historical article.pt (263287) 20 Review of reported cases.pt (0) 21 Review,multicase.pt (0) 22 17 or 18 or 19 or 20 or 21 (1098644) 23 16 not 22 (822810) 24 Breast/ or Breast Diseases/ (30717) 25 Neoplasms/ (216644) 26 24 and 25 (535) 27 (breast$ adj5 neoplasm$).tw (1588) 28 (breast$ adj5 cancer$).tw (135654) 29 (breast$ adj5 carcin$).tw (31778) 30 (breast$ adj5 tumo$).tw (23438) 31 (breast$ adj5 metasta$).tw (16580) 32 (breast$ adj5 malig$).tw (7361) 33 exp Breast Neoplasms/ (171606) 34 exp Carcinoma, Ductal, Breast/ (8460) 35 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 (207174) 36 mammography.mp (23598) 37 screening.mp (274211) 38 36 or 37 (288429) 39 23 and 35 and 38 (2326) 40 limit 39 to (yr=" 2008 -Current" and " all adult (19 plus years)" and (dutch or english or french)) (241) 41 from 40 keep 1-241 (241) 42 from 41 keep 1-241 (241) CENTRAL Breast neoplasms (MESH) and early detection (MESH) or 61 mammography (MESH) (manual limit 2008-2010) in title , abstracts or key words

Table 5: Update of evidence found in SR and HTA Search Radiation harms of mammography screening (40-49 y) questions Note Update of HTA (ETMIS) Date 03/05/2010 Keywords Breast neoplasms, mammography/ adverse effects, mass screening/ adverse effects Medline Case report.tw (156081) (OVID): 2 Letter.pt (689184) Filter 3 Historical article.pt (263481) RCT 4 Review of reported cases.pt (0) 5 Review,multicase.pt (0) 6 or/1-5 (1099551) 7 Breast/ or Breast Diseases/ (30731) 8 Neoplasms/ (216844) 9 7 and 8 (536) 10 exp Breast Neoplasms/ (171800) 11 (breast$ adj5 neoplas$).tw (2557) 12 (breast$ adj5 cancer$).tw (135752) 13 (breast$ adj5 carcin$).tw (31777) 14 (breast$ adj5 tumo$).tw (23441) 15 (breast$ adj5 metasta$).tw (16582) 16 (breast$ adj5 malig$).tw (7361) 17 exp Carcinoma, Ductal, Breast/ (8472) 18 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 (207367) 19 Mammography/ae [Adverse Effects] (517) 20 Mass Screening/ae [Adverse Effects] (325) 21 19 or 20 (763) 22 18 and 21 (443) 23 22 not 6 (379) 24 limit 23 to (yr=" 2005 -Current" and " all adult (19 plus years)" and (dutch or english or french)) (44) 25 from 24 keep 1-44 (44)
Table 3: Update of evidence found in SR and HTA Search Radiation harms of mammography screening (40-49 y) questions Note Update of HTA (ETMIS) Date 03/05/2010 Keywords Breast neoplasms, mammography/ adverse effects, mass screening/ adverse effects Medline Case report.tw (156081) (OVID): 2 Letter.pt (689184) Filter 3 Historical article.pt (263481) RCT 4 Review of reported cases.pt (0) 5 Review,multicase.pt (0) 6 or/1-5 (1099551) 7 Breast/ or Breast Diseases/ (30731) 8 Neoplasms/ (216844) 9 7 and 8 (536) 10 exp Breast Neoplasms/ (171800) 11 (breast$ adj5 neoplas$).tw (2557) 12 (breast$ adj5 cancer$).tw (135752) 13 (breast$ adj5 carcin$).tw (31777) 14 (breast$ adj5 tumo$).tw (23441) 15 (breast$ adj5 metasta$).tw (16582) 16 (breast$ adj5 malig$).tw (7361) 17 exp Carcinoma, Ductal, Breast/ (8472) 18 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 (207367) 19 Mammography/ae [Adverse Effects] (517) 20 Mass Screening/ae [Adverse Effects] (325) 21 19 or 20 (763) 22 18 and 21 (443) 23 22 not 6 (379) 24 limit 23 to (yr=" 2005 -Current" and " all adult (19 plus years)" and (dutch or english or french)) (44) 25 from 24 keep 1-44 (44)

Table 9: Evidence form systematic reviews and meta analysis (breast cancer mortality reduction in intervention group) Study ID Ref Population Intervention Results of meta-analysis Comments Level of evidence
Table 7: Evidence form systematic reviews and meta analysis (breast cancer mortality reduction in intervention group) Study ID Ref Population Intervention Results of meta-analysis Comments Level of evidence

11. Biesheuvel C, Barratt A, Howard K, Houssami N, Irwig L. Effects of study methods and biases on estimates of invasive breast cancer overdetection with mammography screening: a systematic review.
11. Jorgensen KJ, Gotzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends.

65. Flobbe K, Nelemans PJ, Kessels AGH, Beets GL, von Meyenfeldt MF, van Engelshoven JMA. The role of ultrasonography as an adjunct to mammography in the detection of breast cancer. a systematic review.
66. Irwig L, Houssami N, van Vliet C. New technologies in screening for breast cancer: a systematic review of their accuracy.