McCarthy E P, Burns R B, Freund K M, Ash A S, Shwartz M, Marwill S L, Moskowitz M A
Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
J Am Geriatr Soc. 2000 Oct;48(10):1226-33. doi: 10.1111/j.1532-5415.2000.tb02595.x.
Women age 65 years and older account for most newly diagnosed breast cancers and deaths from breast cancer. Yet, older women are least likely to undergo mammography, perhaps because mammography's value is less well demonstrated in older women.
To investigate the relationship between prior mammography use, cancer stage at diagnosis, and breast cancer mortality among older women with breast cancer.
Retrospective cohort study using the Linked Medicare-Tumor Registry Database.
Population-based data from three geographic areas included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.
Women aged 67 and older diagnosed with a first primary breast cancer, from 1987 to 1993, residing in Connecticut, metropolitan Atlanta, Georgia, or Seattle-Puget Sound, Washington.
Medicare claims were reviewed and women were classified according to their mammography use during the 2 years before diagnosis: nonusers (no prior mammograms), regular users (at least two mammograms at least 10 months apart), or peri-diagnosis users (only mammogram(s) within 3 months before diagnosis). Mammography utilization was linked with SEER data to determine stage at diagnosis and cause of death. Our main outcome variables were (1) stage at diagnosis, classified as early (in situ/Stage I) or late (Stage II or greater), and (2) breast cancer mortality, measured from diagnosis until death from breast cancer or end of the follow-up period (December 31, 1994).
Older women who were nonusers of mammography were diagnosed with breast cancer at Stage II or greater more often than regular users (adjusted odds ratio (OR), 3.12; 95% confidence interval (CI), 2.74-3.58). This association was present within each age group studied. Nonusers of mammography were at significantly greater risk of dying from their breast cancer than regular users for all women (adjusted hazard ratio (HR), 3.38; 95% CI, 2.65-4.32) and for women within each age group. Even assuming a lead time of 1.25 years, nonusers of mammography continued to be at increased risk of dying from breast cancer. Our findings remained significant for all women and for the two youngest age groups (67-74 years, 75-85 years), although the benefit was no longer statistically significant for the oldest women (85 years and older).
Older women who undergo regular mammography are diagnosed with an earlier stage of disease and are less likely to die from their disease. These data support the use of regular mammography in older women and suggest that mammography can reduce breast cancer mortality in older women, even for women age 85 and older.
65岁及以上的女性占新诊断出的乳腺癌病例及乳腺癌死亡病例的大多数。然而，老年女性接受乳房X光检查的可能性最小，这可能是因为乳房X光检查在老年女性中的价值尚未得到充分证明。
研究老年乳腺癌女性先前乳房X光检查的使用情况、诊断时的癌症分期与乳腺癌死亡率之间的关系。
使用医疗保险与肿瘤登记关联数据库进行的回顾性队列研究。
来自美国国家癌症研究所监测、流行病学和最终结果（SEER）计划中三个地理区域的基于人群的数据。
1987年至1993年期间，居住在康涅狄格州、佐治亚州大都市亚特兰大或华盛顿州西雅图-普吉特海湾地区，年龄在67岁及以上且被诊断为原发性乳腺癌的女性。
审查医疗保险理赔记录，并根据女性在诊断前2年内的乳房X光检查使用情况进行分类：未使用者（之前未进行过乳房X光检查）、定期使用者（至少间隔10个月进行过两次乳房X光检查）或诊断前使用者（仅在诊断前3个月内进行过乳房X光检查）。将乳房X光检查的使用情况与SEER数据相关联，以确定诊断时的分期和死因。我们的主要结局变量为：（1）诊断时的分期，分为早期（原位癌/Ⅰ期）或晚期（Ⅱ期或更高分期）；（2）乳腺癌死亡率，从诊断开始直至因乳腺癌死亡或随访期结束（1994年12月31日）。
未进行乳房X光检查的老年女性被诊断为Ⅱ期或更高分期乳腺癌的频率高于定期使用者（调整后的优势比（OR）为3.12；95%置信区间（CI）为2.74 - 3.58）。这种关联在每个研究年龄组中均存在。对于所有女性以及每个年龄组中的女性，未进行乳房X光检查的女性死于乳腺癌的风险显著高于定期使用者（调整后的风险比（HR）为3.38；95%CI为2.65 - 4.32）。即使假设存在1.25年的提前期，未进行乳房X光检查的女性死于乳腺癌的风险仍然较高。我们的研究结果在所有女性以及两个最年轻的年龄组（67 - 74岁、75 - 85岁）中仍然显著，尽管对于最年长的女性（85岁及以上），这种益处不再具有统计学意义。
接受定期乳房X光检查的老年女性被诊断出的疾病分期更早，死于该疾病的可能性更小。这些数据支持在老年女性中使用定期乳房X光检查，并表明乳房X光检查可以降低老年女性的乳腺癌死亡率，即使对于85岁及以上的女性也是如此。
