Objectives. To systematically review the evidence for population-based mammography as applied to a Chinese population.

Methods. Primary reports for the meta-analysis were identified by a search of MEDLINE and the Cochrane Library. Information on breast cancer incidence and mortality was collected from the International Agency for Research on Cancer and the Hong Kong Cancer Registry. Outcome measures included breast cancer-related mortality, the number needed to screen (NNS) to prevent one death, and the positive
predictive value (PPV) of mammography.

Results. The pooled relative risk for breast cancer-related death in the screened group was 0.80 (95% confidence interval = 0.71, 0.90). When applied to Hong Kong this translates into an NNS of 1,302 healthy women screened annually for 10 years to prevent one death. The PPV of mammography was between 1.8% and 13.4%. Therefore, for 100,000 Hong Kong Chinese women aged 50 or over screened annually
for 10 years we would expect 8,980 false positive cases, 134 of them would sustain a biopsy-related complication. Only 77 breast cancer-related deaths would be avoided, assuming trial conditions and 100% uptake and follow-up.

Conclusions. There is insufficient evidence to justify population-based breast cancer screening by mammography for women in Hong Kong and other Asian populations with low breast cancer prevalence.