Pinckney Richard G, Geller Berta M, Burman Marcia, Littenberg Benjamin
Division of General Internal Medicine, University of Vermont College of Medicine, Burlington, USA.
Am J Med. 2003 Feb 1;114(2):120-5. doi: 10.1016/s0002-9343(02)01438-9.
There has been concern that false-positive mammograms may deter women from future screening mammograms. We sought to determine whether false-positive mammograms affected follow-up for rescreening. We studied a cohort of 41,844 women in the Vermont Mammography Registry. We measured the proportion of women returning for the next screening mammogram for 30 months following an initial screening mammogram, and compared rates of follow-up screening at 18 and 30 months in women with false-positive and true-negative initial mammograms. We adjusted for potential confounders using multivariable logistic regression models. Of the 2469 women aged 50 years or older with false-positive mammograms, 67.2% (n = 1660) returned at 18 months for rescreening, compared with 63.9% (16,948/26,521) of the women with true-negative mammograms (P = 0.001). Similarly, 86.8% (2143/2469) of the women with false-positive mammograms returned at 30 months for rescreening, compared with 84.7% (22,466/26,521) of the women with true-negative mammograms (P = 0.005). After adjusting for age, use of hormone replacement therapy, prior mammography, prior false-positive mammography, and education, women with false-positive mammograms were more likely to return at 18 months (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.30 to 1.51) and at 30 months (OR = 1.30; 95% CI: 1.18 to 1.44). Despite previous concerns, false-positive screening mammograms did not discourage women from returning for subsequent screening mammography. However, other deleterious effects of false-positive results still warrant improvements in the accuracy of breast cancer screening.
一直有人担心乳腺钼靶检查的假阳性结果可能会使女性不再进行后续的钼靶筛查。我们试图确定假阳性的乳腺钼靶检查结果是否会影响复查筛查的后续跟进情况。我们研究了佛蒙特州乳腺钼靶登记处的41,844名女性队列。我们测量了在首次乳腺钼靶筛查后的30个月内返回进行下一次筛查钼靶检查的女性比例,并比较了初始钼靶检查为假阳性和真阴性的女性在18个月和30个月时的后续筛查率。我们使用多变量逻辑回归模型对潜在的混杂因素进行了调整。在2469名50岁及以上钼靶检查为假阳性的女性中,67.2%(n = 1660)在18个月时返回进行复查筛查,而钼靶检查为真阴性的女性中这一比例为63.9%(16,948/26,521)(P = 0.001)。同样,钼靶检查为假阳性的女性中86.8%(2143/2469)在30个月时返回进行复查筛查,而钼靶检查为真阴性的女性中这一比例为84.7%(22,466/26,521)(P = 0.005)。在对年龄、激素替代疗法的使用、既往钼靶检查、既往假阳性钼靶检查结果和教育程度进行调整后,钼靶检查为假阳性的女性在18个月时更有可能返回(优势比[OR] = 1.40;95%置信区间[CI]:1.30至1.51),在30个月时也是如此(OR = 1.30;95%CI:1.18至1.44)。尽管此前存在担忧,但假阳性的筛查钼靶检查结果并未阻碍女性返回进行后续的筛查钼靶检查。然而,假阳性结果的其他有害影响仍然需要提高乳腺癌筛查的准确性。