Cardiovascular Mortality Associated with Mammographic Screening

Abstract

Introduction: Cardiovascular harms of mammographic screening have not been the subject of study or concern, including in the cardio-oncology area of. The result is an important gap in literature despite the evidence of great magnitude of overdiagnosis and overtreatment in screening and its association with increased cardiovascular mortality. Objective: Present and discuss the main evidence regarding the causes of increased cardiovascular mortality associated with screening. Method: Systematic searches were performed in the literature through four search strategies in two databases (MEDLINE and LILACS), to identify the causes of increased cardiovascular mortality potentially associated with overdiagnosis and overtreatment. For each one of the search strategies, it was used the classification of the Oxford Centre for Evidence-Based Medicine to assign the level of evidence of the results. Results: Two major groups of causes of increased cardiovascular mortality were identified: the first linked directly to the diagnosis of breast cancer; and the second to the treatment of breast cancer, including surgery and adjuvant radiotherapy. The increase of cardiovascular mortality included several subgroups of causes such as acute myocardial infarction, pulmonary thromboembolism, heart failure, arrhythmias, heart valve disease and stroke. Conclusion: There are consistent evidence about cardiovascular mortality associated with breast cancer diagnosis and treatment in conditions clinically compatible with screening. It is also likely to be one of the most important causes of mortality related to screening, especially those associated with overtreatment with adjuvant radiotherapy.