Bobo J, Lee N
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
Ann Epidemiol. 2000 Oct 1;10(7):463. doi: 10.1016/s1047-2797(00)00099-5.
Although most US women who undergo mammography screening also receive a Clinical Breast Examination (CBE), factors that predict cancer detection during a CBE have not been well studied to date.METHODS: We analyzed 752,081 National Breast and Cervical Cancer Early Detection Program (NBCCEDP) screening records for CBEs performed from July 1, 1995 thru June 30, 1998 on low income women across the US. CBE results are reported as "normal" or "abnormal, suspicious for cancer." Other variables include CBE date, age, race, ethnicity, presence of breast symptoms at screening, and whether the woman had received a prior NBCCEDP-funded CBE. Most (74%) records include mammography dates and results. Tumor stage and size are reported for invasive cancers whether detected by CBE or mammography.RESULTS: Breast cancer was reported on 3,780 records. On 2,224 records, the CBE was suspicious for cancer. On 1,556 records, the CBE was normal. Most (93%) cancer records with a normal CBE had abnormal mammography results. Bivariate comparisons between normal and abnormal CBE records with a cancer diagnosis found significant differences (p <.001) in age, race/ethnicity, presence of breast symptoms, history of a prior NBCCEDP CBE, and tumor stage and size. In a logistic model controlling for these variables, women with breast symptoms were more likely to have their cancer detected during CBE (OR = 7.0, 95% CI = 5.9-8.5), while women with a prior NBCCEDP CBE were less likely to have their cancer detected (OR = 0.7, 95% CI = 0.6-0.8). Compared to women aged 50-59 years, women <40 were more likely to have their cancer detected by CBE (OR = 3.2, 95% CI = 1.9-5.4) but women >/=70 were less likely (OR = 0.7, 95% CI = 0.5-0.9). Larger cancers and those at more advanced stages were much more likely to be detected during CBE.CONCLUSIONS: Among low-income women whose cancers were detected through the NBCCEDP, older women and those who had been screened previously in the program were less likely to have their cancer detected during a CBE, even after controlling for tumor size and stage.
尽管大多数接受乳房X光筛查的美国女性也会接受临床乳房检查（CBE），但迄今为止，预测CBE期间癌症检测的因素尚未得到充分研究。方法：我们分析了1995年7月1日至1998年6月30日期间在美国对低收入女性进行的752,081份全国乳腺癌和宫颈癌早期检测项目（NBCCEDP）筛查记录中的CBE记录。CBE结果报告为“正常”或“异常，疑似癌症”。其他变量包括CBE日期、年龄、种族、民族、筛查时乳房症状的存在情况，以及该女性是否曾接受过NBCCEDP资助的CBE。大多数（74%）记录包括乳房X光检查日期和结果。报告了浸润性癌症的肿瘤分期和大小，无论其是通过CBE还是乳房X光检查检测到的。结果：3780份记录报告了乳腺癌。2224份记录中，CBE疑似癌症。1556份记录中，CBE正常。大多数（93%）CBE正常但患有癌症的记录，其乳房X光检查结果异常。对有癌症诊断的正常和异常CBE记录进行双变量比较发现，在年龄、种族/民族、乳房症状的存在情况、之前接受NBCCEDP CBE的病史以及肿瘤分期和大小方面存在显著差异（p<.001）。在控制这些变量的逻辑模型中，有乳房症状的女性在CBE期间更有可能检测出癌症（OR = 7.0，95%CI = 5.9 - 8.5），而之前接受过NBCCEDP CBE的女性检测出癌症的可能性较小（OR = 0.7，95%CI = 0.6 - 0.8）。与50 - 59岁的女性相比，<40岁的女性通过CBE检测出癌症的可能性更大（OR = 3.2，95%CI = 1.9 - 5.4），但≥70岁的女性可能性较小（OR = 0.7，95%CI = 0.5 - 0.9）。更大的癌症以及处于更晚期阶段的癌症在CBE期间更有可能被检测到。结论：在通过NBCCEDP检测出癌症的低收入女性中，年龄较大的女性以及那些之前在该项目中接受过筛查的女性，即使在控制了肿瘤大小和分期之后，在CBE期间检测出癌症的可能性也较小。
