不同的指导小组和个人可能会部分根据他们的偏好做出不同的决定。支持或反对某项干预措施的偏好被视为人们对其预期或经历的健康结果的相对重要性的结果。然后，在平衡筛查计划临床有效性的经验证据所报告的益处和危害的效果估计时，这些发现可以被视为患者的输入。 本系统综述更新检查了患者对基于乳房 X 线摄影的乳腺癌筛查的潜在益处和危害的相对重要性，为 2018 年加拿大预防保健工作组筛查指南的更新提供信息。我们筛选了之前综述中的所有文章（搜索时间为 2017 年 12 月），并将我们在 MEDLINE、PsycINFO 和 CINAHL 中的搜索更新至 2023 年 6 月 19 日。我们还筛选了灰色文献、利益相关者提交的材料和参考文献列表。目标人群是顺性别女性和其他出生时被指定为女性的成年人（包括跨性别男性和非二元性别人士），年龄≥35岁，且患乳腺癌的风险平均或中度增加。对乳腺癌患者的研究有资格获得相关结果的健康状况效用数据。 我们直接通过以下方式寻求三种类型的数据：(i) 筛查和治疗健康状况的负效用（衡量结果对个人健康相关生活质量的影响；效用按 0 [死亡] 到 1 [完美] 的等级进行衡量健康]），以及（ii）其他基于偏好的数据，例如结果权衡，以及间接通过（iii）从患者对筛查的态度、意图和行为推断出的益处与危害的相对重要性，并提供估计值益处和危害的程度。对于筛选，在至少 50% 的研究经过人类重复审核后，我们使用机器学习作为审核者之一；全文选择由两个人独立审阅。数据提取和偏倚风险评估由一名审核员进行验证。我们对公用事业的主要分析使用了来自基于公用事业的患者健康相关生活质量工具（例如 EQ-5D）的数据；对于加拿大公众来说，大约 0.04 的负效用值可以被视为最低限度的重要值。在合适的情况下，我们汇集实用程序并探索异质性。计算了筛选健康状态以及不同治疗状态之间的负效用。根据比较结果（例如权衡数据）、参与者年龄以及我们对研究描绘的筛查净效益的判断，将非效用数据分为几类。此后，我们在考虑样本量、偏倚风险、亚组研究结果和知识得分数据的同时，对研究结果进行了比较和对比，并为每个数据集创建了总结陈述。确定性评估遵循患者偏好的 GRADE 指南，并使用至少两名评审员的共识。纳入了 82 项研究（38 项关于公用事业）。阳性筛查结果的估计负效用为 0.07（中等确定性），假阳性（FP；“附加测试”解析为癌症阴性）为 0.03-0.04（低确定性），未经治疗的筛查检测到的癌症为 0.08（中等确定性）。确定性）或（低确定性）间期癌症。在 ≤ 12 个月时，乳房切除术（与保乳治疗相比）、化疗（与无治疗相比）（低确定性）和放射治疗（与无治疗相比）（中等确定性）的弊端分别为 0.02-0.03、0.02-0.04 和尽管在每种情况下，研究结果的适用性都受到一定程度的限制，但几乎没有。从长远来看，与放疗保乳手术/肿块切除术和放疗相比，乳房切除术几乎没有副作用，有中等程度的确定性。有中等程度的确定性表明，大多数 (>50%) 甚至可能是绝大多数 (>75%) 女性可能会接受最多六例过度诊断，以防止一名乳腺癌死亡；存在一些不确定性，因为有迹象表明，在某些情况下，参与者并未完全理解过度诊断。低质量证据表明，绝大多数人可能接受筛查可以降低乳腺癌，但不能降低全因死亡率，至少在乳腺癌死亡率降低率相对较高的情况下（n = 2；每 1000 名筛查者减少 2 人和 5 人） ），并且至少大多数人认为，为了预防一名乳腺癌死亡，至少数百名患者将收到 FP 结果，其中 10-15 名患者将通过活检得到 FP 解决。未评估可接受的 FP 数量上限。 当使用评估所有年龄组的态度、意图和筛查行为的研究数据时，尤其是 40 多岁的女性，偏好随着研究作者提出的净收益幅度的下降而减少。在净收益相对较低的情况下，大多数 40 多岁的患者可能不会权衡筛查的益处大于危害，而对于 50 多岁的女性来说，绝大多数可能更喜欢筛查（两个年龄段的证据质量都较低）。有一定程度的确定性的是，大多数 50 岁和 50 至 69 岁的女性通常经历过筛查，她们认为在高净收益情况下筛查的好处大于坏处。大多数最近接受过筛查的 70-71 岁患者可能认为继续筛查的好处大于坏处。大多数 70 多岁至 80 岁出头的女性可能更愿意继续筛查。有关知情患者如何评价乳腺癌筛查潜在结果的一系列数据来源的证据，将在决策建议过程中发挥作用。证据表明，所检查的所有结果对任何年龄的女性都很重要，不同年龄组之间和不同年龄组内的不同结果之间的可接受的影响程度至少存在一些甚至可能是实质性的差异，并且为了做出明智的决策，可能需要提供有关结果可能性的易于理解的信息。尽管研究来自多个国家，但来自加拿大的数据以及有关研究结果是否适用于民族志和社会经济多样化人群的数据有限。协议可在开放科学框架 https://osf.io/xngsu/ 上找到。© 2024。作者。

Different guideline panels, and individuals, may make different decisions based in part on their preferences. Preferences for or against an intervention are viewed as a consequence of the relative importance people place on the expected or experienced health outcomes it incurs. These findings can then be considered as patient input when balancing effect estimates on benefits and harms reported by empirical evidence on the clinical effectiveness of screening programs. This systematic review update examined the relative importance placed by patients on the potential benefits and harms of mammography-based breast cancer screening to inform an update to the 2018 Canadian Task Force on Preventive Health Care's guideline on screening.We screened all articles from our previous review (search December 2017) and updated our searches to June 19, 2023 in MEDLINE, PsycINFO, and CINAHL. We also screened grey literature, submissions by stakeholders, and reference lists. The target population was cisgender women and other adults assigned female at birth (including transgender men and nonbinary persons) aged ≥ 35 years and at average or moderately increased risk for breast cancer. Studies of patients with breast cancer were eligible for health-state utility data for relevant outcomes. We sought three types of data, directly through (i) disutilities of screening and curative treatment health states (measuring the impact of the outcome on one's health-related quality of life; utilities measured on a scale of 0 [death] to 1 [perfect health]), and (ii) other preference-based data, such as outcome trade-offs, and indirectly through (iii) the relative importance of benefits versus harms inferred from attitudes, intentions, and behaviors towards screening among patients provided with estimates of the magnitudes of benefit(s) and harms(s). For screening, we used machine learning as one of the reviewers after at least 50% of studies had been reviewed in duplicate by humans; full-text selection used independent review by two humans. Data extraction and risk of bias assessments used a single reviewer with verification. Our main analysis for utilities used data from utility-based health-related quality of life tools (e.g., EQ-5D) in patients; a disutility value of about 0.04 can be considered a minimally important value for the Canadian public. When suitable, we pooled utilities and explored heterogeneity. Disutilities were calculated for screening health states and between different treatment states. Non-utility data were grouped into categories, based on outcomes compared (e.g. for trade-off data), participant age, and our judgements of the net benefit of screening portrayed by the studies. Thereafter, we compared and contrasted findings while considering sample sizes, risk of bias, subgroup findings and data on knowledge scores, and created summary statements for each data set. Certainty assessments followed GRADE guidance for patient preferences and used consensus among at least two reviewers.Eighty-two studies (38 on utilities) were included. The estimated disutilities were 0.07 for a positive screening result (moderate certainty), 0.03-0.04 for a false positive (FP; "additional testing" resolved as negative for cancer) (low certainty), and 0.08 for untreated screen-detected cancer (moderate certainty) or (low certainty) an interval cancer. At ≤12 months, disutilities of mastectomy (vs. breast-conserving therapy), chemotherapy (vs. none) (low certainty), and radiation therapy (vs. none) (moderate certainty) were 0.02-0.03, 0.02-0.04, and little-to-none, respectively, though in each case findings were somewhat limited in their applicability. Over the longer term, there was moderate certainty for little-to-no disutility from mastectomy versus breast-conserving surgery/lumpectomy with radiation and from radiation. There was moderate certainty that a majority (>50%) and possibly a large majority (>75%) of women probably accept up to six cases of overdiagnosis to prevent one breast-cancer death; there was some uncertainty because of an indication that overdiagnosis was not fully understood by participants in some cases. Low certainty evidence suggested that a large majority may accept that screening may reduce breast-cancer but not all-cause mortality, at least when presented with relatively high rates of breast-cancer mortality reductions (n = 2; 2 and 5 fewer per 1000 screened), and at least a majority accept that to prevent one breast-cancer death at least a few hundred patients will receive a FP result and 10-15 will have a FP resolved through biopsy. An upper limit for an acceptable number of FPs was not evaluated. When using data from studies assessing attitudes, intentions, and screening behaviors, across all age groups but most evident for women in their 40s, preferences reduced as the net benefit presented by study authors decreased in magnitude. In a relatively low net-benefit scenario, a majority of patients in their 40s may not weigh the benefits as greater than the harms from screening whereas for women in their 50s a large majority may prefer screening (low certainty evidence for both ages). There was moderate certainty that a large majority of women 50 years of age and 50 to 69 years of age, who have usually experienced screening, weigh the benefits as greater than the harms from screening in a high net-benefit scenario. A large majority of patients aged 70-71 years who have recently screened probably think the benefits outweigh the harms of continuing to screen. A majority of women in their mid-70s to early 80s may prefer to continue screening.Evidence across a range of data sources on how informed patients value the potential outcomes from breast-cancer screening will be useful during decision-making for recommendations. The evidence suggests that all of the outcomes examined have importance to women of any age, that there is at least some and possibly substantial (among those in their 40s) variability across and within age groups about the acceptable magnitude of effects across outcomes, and that provision of easily understandable information on the likelihood of the outcomes may be necessary to enable informed decision making. Although studies came from a wide range of countries, there were limited data from Canada and about whether findings applied well across an ethnographically and socioeconomically diverse population.Protocol available at Open Science Framework https://osf.io/xngsu/ .© 2024. The Author(s).