Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Journal of breast imaging
Contrast-Enhanced Mammography for Breast Cancer Screening: A Systematic Review and Meta-Analysis
OBJECTIVE: To evaluate pathway-specific cancer detection and summarise screening outcomes (recall/biopsy/PPV3) for contrast-enhanced mammography when reported, and to compare them with those for low-energy mammography and breast MRI. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. PubMed (MEDLINE), Embase, Scopus, and Web of Science were searched from January 1, 2011, through August 31, 2025, for studies evaluating contrast-enhanced mammography in screening or surveillance populations (including supplemental/add-on screening and surveillance of patients with a personal history of breast cancer). Diagnostic, recall, and problem-solving studies were excluded. Screening pathways were categorized as: (1) direct comparison with low-energy mammography, (2) direct comparison with MRI, and (3) add-on CEM to mammography-based screening. Random-effects meta-analyses were performed when designs were comparable. Comparisons between CEM and MRI were summarized qualitatively because of heterogeneity and limited cancer events across studies. Single-arm screening studies were summarized descriptively. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). RESULTS: Fourteen studies met eligibility criteria for qualitative synthesis; seven screening and surveillance studies contributed to the meta-analysis. Compared with low-energy mammography, CEM detected 9.3 additional cancers per 1,000 women screened (risk difference [RD], +9.3 per 1,000; 95% CI, 4.0-14.6; P < 0.01; I2 = 0%). Three studies directly compared CEM with MRI in screening settings and were summarized qualitatively because of heterogeneity and limited cancer events. CONCLUSION: In screening and surveillance populations, contrast-enhanced mammography increases cancer detection compared with low-energy mammography. Evidence from available comparative studies suggests that cancer detection with CEM may be broadly comparable to MRI in selected screening contexts; however, the limited number of studies and heterogeneous designs preclude definitive comparative conclusions. These pathway-specific estimates may inform clinical implementation and the design of prospective screening trials.
30 July 2026
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Mobile health strategies to improve HPV vaccination uptake among parents of adolescent girls: a scoping review
BACKGROUND: Human papillomavirus (HPV) vaccination is a highly effective primary prevention strategy against cervical cancer. However, despite strong evidence of vaccine efficacy and safety, uptake among adolescent girls remains suboptimal globally, particularly in low- and middle-income countries. Mobile health (mHealth) technologies have emerged as promising tools to address parental concerns, reduce vaccine hesitancy, and strengthen parental engagement in vaccination decision-making. OBJECTIVE: This scoping review aimed to synthesize evidence on the types of mHealth strategies implemented to improve HPV vaccine uptake among parents of adolescent girls and to examine the outcomes of these interventions. METHODS: A systematic search of major databases identified studies evaluating mHealth interventions targeting parental decision-making regarding HPV vaccination. Eligible interventions included text messaging, mobile applications, chatbots, web-based educational platforms, and other digital health tools. Data were charted and synthesized narratively. KEY FINDINGS: mHealth interventions were associated with significant improvements in HPV vaccine uptake across multiple settings. SMS-based interventions consistently increased vaccination rates, while chatbot, web-based, and mobile app interventions improved parental knowledge, vaccine literacy, intention to vaccinate, and, in several studies, actual vaccine uptake. However, intervention effectiveness varied by socioeconomic context, digital access, and cultural factors. CONCLUSION: mHealth technologies represent cost-effective and scalable strategies to improve HPV vaccine uptake by enhancing parental knowledge, reducing hesitancy, and supporting informed decision-making. Future implementation should prioritize culturally tailored, equity-focused approaches and integrate digital interventions with community-based engagement to maximize impact.
12 July 2026
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