Christiansen C L, Wang F, Barton M B, Kreuter W, Elmore J G, Gelfand A E, Fletcher S W
Boston University School of Public Health, Health Services Department, and Center for Health Quality, Outcomes and Economic Research at Veterans Affairs Health Services Research and Development, Boston, MA 01730, USA.
J Natl Cancer Inst. 2000 Oct 18;92(20):1657-66. doi: 10.1093/jnci/92.20.1657.
The cumulative risk of a false-positive mammogram can be substantial. We studied which variables affect the chance of a false-positive mammogram and estimated cumulative risks over nine sequential mammograms.
We used medical records of 2227 randomly selected women who were 40-69 years of age on July 1, 1983, and had at least one screening mammogram. We used a Bayesian discrete hazard regression model developed for this study to test the effect of patient and radiologic variables on a first false-positive screening and to calculate cumulative risks of a false-positive mammogram.
Of 9747 screening mammograms, 6. 5% were false-positive; 23.8% of women experienced at least one false-positive result. After nine mammograms, the risk of a false-positive mammogram was 43.1% (95% confidence interval [CI] = 36.6%-53.6%). Risk ratios decreased with increasing age and increased with number of breast biopsies, family history of breast cancer, estrogen use, time between screenings, no comparison with previous mammograms, and the radiologist's tendency to call mammograms abnormal. For a woman with highest-risk variables, the estimated risk for a false-positive mammogram at the first and by the ninth mammogram was 98.1% (95% CI = 69.3%-100%) and 100% (95% CI = 99.9%-100%), respectively. A woman with lowest-risk variables had estimated risks of 0.7% (95% CI = 0.2%-1.9%) and 4.6% (95% CI = 1. 1%-12.5%), respectively.
The cumulative risk of a false-positive mammogram over time varies substantially, depending on a woman's own risk profile and on several factors related to radiologic screening. By the ninth mammogram, the risk can be as low as 5% for women with low-risk variables and as high as 100% for women with multiple high-risk factors.
乳腺钼靶检查假阳性的累积风险可能相当大。我们研究了哪些变量会影响乳腺钼靶检查假阳性的几率，并估计了连续九次乳腺钼靶检查的累积风险。
我们使用了2227名随机选取的女性的医疗记录，这些女性在1983年7月1日年龄为40 - 69岁，且至少进行过一次乳腺钼靶筛查。我们使用为本研究开发的贝叶斯离散风险回归模型来测试患者和放射学变量对首次假阳性筛查的影响，并计算乳腺钼靶检查假阳性的累积风险。
在9747次乳腺钼靶筛查中，6.5%为假阳性；23.8%的女性至少经历过一次假阳性结果。经过九次乳腺钼靶检查后，乳腺钼靶检查假阳性的风险为43.1%（95%置信区间[CI]=36.6% - 53.6%）。风险比随年龄增加而降低，随乳腺活检次数、乳腺癌家族史、雌激素使用、筛查间隔时间、未与之前的乳腺钼靶检查进行比较以及放射科医生将乳腺钼靶检查判为异常的倾向而增加。对于具有最高风险变量的女性，首次和第九次乳腺钼靶检查时假阳性的估计风险分别为98.1%（95%CI = 69.3% - 100%）和100%（95%CI = 99.9% - 100%）。具有最低风险变量的女性估计风险分别为0.7%（95%CI = 0.2% - 1.9%）和4.6%（95%CI = 1.1% - 12.5%）。
随着时间推移，乳腺钼靶检查假阳性的累积风险差异很大，这取决于女性自身的风险状况以及与放射学筛查相关的几个因素。到第九次乳腺钼靶检查时，低风险变量女性的风险可低至5%，而具有多个高风险因素的女性风险可高达100%。
