乳腺钼靶筛查与晚期乳腺癌：一项基于人群的研究。

Wu Y, Weissfeld J L, Weinberg G B, Kuller L H

Department of Epidemiology (Graduate School of Public Health), University of Pittsburgh, Pennsylvania, USA.

Prev Med. 1999 Jun;28(6):572-8. doi: 10.1006/pmed.1999.0483.

BACKGROUND

Among 50- to 69-year-old women, randomized clinical trials show breast cancer mortality reductions from screening mammography. However, few studies examine the long-term health effects and outcomes from screening mammography in community practice. The purpose of this study was to evaluate one approach for determining the effectiveness of screening mammography, as it is practiced in community settings, and to measure the prevalence of prior screening mammography among women with incident breast cancer.

METHODS

This study was a population-based survey of the general community. Participants were 406 women with breast cancer diagnosed in 1993. The main outcome measure was breast cancer, late stage at diagnosis or fatal within 2 to 3 years of diagnosis.

RESULTS

Sixty-four (57.7%) of 111 women with late-stage and 123 (42.1%) of 292 women with early-stage breast cancer did not have a screening mammogram in the 4 calendar years (1989-1992) before diagnosis. Relative to women with early-stage breast cancer, mammography nonuse in 1989-1992 was significantly more frequent among women with late-stage breast cancer (age-adjusted odds ratio 2.3, 95% confidence interval 1.3-4.3). Prior mammography was particularly infrequent among 42 women with breast cancer incident in 1993 and fatal before January 1996.

CONCLUSIONS

Prior mammography among women with late-stage or fatal breast cancer was relatively infrequent. Late-stage or fatal breast cancer lacking prior mammography constitutes a missed public health opportunity. Also, this population-based study showed the expected association between prior mammography and late-stage or fatal breast cancer. These results are consistent with the effective practice of mammography in a community setting. The results illustrate and validate a public health approach that uses prior mammography histories among women with incident breast cancer to evaluate mammography penetration and quality in defined communities.

背景

在50至69岁的女性中，随机临床试验表明乳腺钼靶筛查可降低乳腺癌死亡率。然而，很少有研究探讨社区实践中乳腺钼靶筛查对长期健康的影响及结果。本研究的目的是评估一种确定社区环境中乳腺钼靶筛查有效性的方法，并测量新发乳腺癌女性中既往乳腺钼靶筛查的患病率。

方法

本研究是一项基于人群的社区调查。参与者为1993年诊断出乳腺癌的406名女性。主要结局指标为乳腺癌，诊断时为晚期或在诊断后2至3年内死亡。

结果

在111名晚期乳腺癌女性中，64名（57.7%）以及在292名早期乳腺癌女性中，123名（42.1%）在诊断前的4个日历年（1989 - 1992年）未进行乳腺钼靶筛查。相对于早期乳腺癌女性，1989 - 1992年未进行钼靶筛查在晚期乳腺癌女性中更为常见（年龄调整优势比2.3，95%置信区间1.3 - 4.3）。在1993年患乳腺癌且于1996年1月前死亡的42名女性中，既往钼靶筛查尤为少见。

结论

晚期或致命性乳腺癌女性中既往钼靶筛查相对较少。缺乏既往钼靶筛查的晚期或致命性乳腺癌构成了错失的公共卫生机会。此外，这项基于人群的研究显示了既往钼靶筛查与晚期或致命性乳腺癌之间预期的关联。这些结果与社区环境中乳腺钼靶筛查的有效实践一致。结果说明了并验证了一种公共卫生方法，即利用新发乳腺癌女性的既往钼靶筛查史来评估特定社区中钼靶筛查的普及率和质量。