Yasmeen Shagufta, Romano Patrick S, Pettinger Mary, Chlebowski Rowan T, Robbins John A, Lane Dorothy S, Hendrix Susan L
University of California, Department of Obstetrics/Gynecology and Internal Medicine, Davis, USA.
J Natl Cancer Inst. 2003 Mar 19;95(6):429-36. doi: 10.1093/jnci/95.6.429.
A recommendation for short-interval follow-up of "probably benign finding" is associated with up to 11% of screening mammograms, but its predictive value for breast cancer is unclear. We examined the predictive values (i.e., the percentage of women with a diagnosis of breast cancer 2 years after a short-interval follow-up recommendation) and likelihood ratios (derived from the pretest and post-test odds of breast cancer in the Women's Health Initiative sample) for breast cancer that are associated with a recommendation for short-interval follow-up among postmenopausal women.
We performed a longitudinal analysis of a prospective cohort of 68 126 postmenopausal women (aged 50-79 years) who were participating in clinical trials as part of the Women's Health Initiative at 40 centers across the United States. Eligible participants had screening mammograms at baseline and at least 2 years of follow-up that included a repeat mammography. Outcomes measured were breast cancer events at 1 and 2 years after baseline and the results of subsequent mammograms. All P values were two-sided.
A total of 2927 (5%) of the 58 408 eligible women had baseline mammograms that included recommendations for short-interval follow-up. The incidence of breast cancer for women with a short-interval follow-up recommendation was 1.0% at 2 years after the baseline mammogram compared with breast cancer incidences of 0.6% and 0.5% for women whose baseline mammograms were described as "benign" and "negative," respectively. Across the 40 participating centers, the prevalence of short-interval follow-up recommendations among baseline mammograms varied from 1.2% to 9.8% (P<.001), even when the analysis was adjusted for key variables in regression models. Centers reporting higher frequencies of such recommendations did not have lower positive predictive values for breast cancer than centers reporting lower frequencies. The likelihood ratio for breast cancer after a recommendation for short-interval follow-up on a subsequent mammogram was 2.20 (95% confidence interval = 1.65 to 2.86).
Having a mammographic recommendation for short-interval follow-up was associated with a low positive predictive value for breast cancer among postmenopausal women during a 2-year follow-up. This result suggests that the current criteria for this recommendation-repeat mammography within 6 months-should be reconsidered.
“可能为良性发现”的短间隔随访建议与高达11%的乳腺筛查钼靶检查相关，但其对乳腺癌的预测价值尚不清楚。我们研究了绝经后女性中与短间隔随访建议相关的乳腺癌预测值（即短间隔随访建议后2年被诊断为乳腺癌的女性百分比）和似然比（源自女性健康倡议样本中乳腺癌的检验前和检验后概率）。
我们对68126名年龄在50 - 79岁的绝经后女性前瞻性队列进行了纵向分析，这些女性作为女性健康倡议的一部分，在美国40个中心参与临床试验。符合条件的参与者在基线时进行了乳腺筛查钼靶检查，并至少随访2年，包括重复钼靶检查。测量的结局是基线后1年和2年的乳腺癌事件以及后续钼靶检查结果。所有P值均为双侧。
在58408名符合条件的女性中，共有2927名（5%）的基线钼靶检查包含短间隔随访建议。与基线钼靶检查被描述为“良性”和“阴性”的女性乳腺癌发病率分别为0.6%和0.5%相比，有短间隔随访建议的女性在基线钼靶检查后2年的乳腺癌发病率为1.0%。在40个参与中心中，即使在回归模型中对关键变量进行了调整，基线钼靶检查中短间隔随访建议的患病率仍在1.2%至9.8%之间变化（P<0.001）。报告此类建议频率较高的中心对乳腺癌的阳性预测值并不低于报告频率较低的中心。后续钼靶检查有短间隔随访建议后乳腺癌的似然比为2.20（95%置信区间 = 1.65至2.86）。
在2年随访期间，钼靶检查有短间隔随访建议与绝经后女性乳腺癌的低阳性预测值相关。这一结果表明，目前该建议（6个月内重复钼靶检查）的标准应重新考虑。
