Carney Patricia A, Miglioretti Diana L, Yankaskas Bonnie C, Kerlikowske Karla, Rosenberg Robert, Rutter Carolyn M, Geller Berta M, Abraham Linn A, Taplin Steven H, Dignan Mark, Cutter Gary, Ballard-Barbash Rachel
Department of Community & Family Medicine, Dartmouth Medical School, 1 Medical Center Drive, HB 7925, Lebanon, NH 03756, USA.
Ann Intern Med. 2003 Feb 4;138(3):168-75. doi: 10.7326/0003-4819-138-3-200302040-00008.
The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated.
To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography.
Prospective cohort study.
7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California.
329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer.
Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography.
Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages.
Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density.
在乳腺癌检测中，乳腺密度、年龄与激素替代疗法（HRT）的使用之间的关系尚未得到充分评估。
确定乳腺密度、年龄和HRT的使用单独及联合使用如何影响乳腺钼靶筛查的准确性。
前瞻性队列研究。
北卡罗来纳州、新墨西哥州、新罕布什尔州、佛蒙特州、科罗拉多州、华盛顿州西雅图市和加利福尼亚州旧金山的7个基于人群的乳腺钼靶登记处。
1996年至1998年期间，年龄在40至89岁之间的329495名女性进行了463372次乳腺钼靶筛查；2223名女性被诊断为乳腺癌。
乳腺密度、年龄、HRT使用情况、乳腺癌发生率以及乳腺钼靶筛查的敏感性和特异性。
调整后的敏感性范围为乳腺极度致密的女性中的62.9%至乳腺几乎完全为脂肪型的女性中的87.0%；调整后的敏感性随年龄增长，从40至44岁女性中的68.6%增至80至89岁女性中的83.3%。调整后的特异性从乳腺极度致密的女性中的89.1%增至乳腺几乎完全为脂肪型的女性中的96.9%。在未使用HRT的女性中，调整后的特异性从40至44岁女性中的91.
