Smith-Bindman Rebecca, Chu Philip W, Miglioretti Diana L, Sickles Edward A, Blanks Roger, Ballard-Barbash Rachel, Bobo Janet K, Lee Nancy C, Wallis Matthew G, Patnick Julietta, Kerlikowske Karla
Department of Radiology, University of California, San Francisco 94115, USA.
JAMA. 2003 Oct 22;290(16):2129-37. doi: 10.1001/jama.290.16.2129.
Screening mammography differs between the United States and the United Kingdom; a direct comparison may suggest methods to improve the practice.
To compare screening mammography performance between the United States and the United Kingdom among similar-aged women.
DESIGN, SETTING, AND PARTICIPANTS: Women aged 50 years or older were identified who underwent 5.5 million mammograms from January 1, 1996, to December 31, 1999, within 3 large-scale mammography registries or screening programs: the Breast Cancer Surveillance Consortium (BCSC, n = 978 591) and National Breast and Cervical Cancer Early Detection Program (NBCCEDP, n = 613 388) in the United States; and the National Health Service Breast Screening Program (NHSBSP, n = 3.94 million) in the United Kingdom. A total of 27 612 women were diagnosed with breast cancer (invasive or ductal carcinoma in situ) within 12 months of screening among the 3 groups.
Recall rates (recommendation for further evaluation including diagnostic imaging, ultrasound, clinical examination, or biopsy) and cancer detection rates were calculated for first and subsequent mammograms, and within 5-year age groups.
Recall rates were approximately twice as high in the United States than in the United Kingdom for all age groups; however, cancer rates were similar. Among women aged 50 to 54 years who underwent a first screening mammogram, 14.4% in the BCSC and 12.5% in the NBCCEDP were recalled for further evaluation vs only 7.6% in the NHSBSP. Cancer detection rates per 1000 mammogram screens were 5.8, 5.9, and 6.3, in the BCSC, NBCCEDP, and NHSBSP, respectively. Recall rates were lower for subsequent examinations in all 3 settings but remained twice as high in the United States. A similar percentage of women underwent biopsy in each setting, but rates of percutaneous biopsy were lower and open surgical biopsy higher in the United States. Open surgical biopsies not resulting in a diagnosis of cancer (negative biopsies) were twice as high in the United States than in the United Kingdom. Based on a 10-year period of screening 1000 women aged 50 to 59 years, 477, 433, and 175 women in the BCSC, NBCCEDP, and NHSBSP, respectively, would be recalled; and for women aged 60 to 69 years, 396, 334, and 133 women, respectively. The estimated cancer detection rates per 1000 women aged 50 to 59 years were 24.5, 23.8, and 19.4, respectively, and for women aged 60 to 69 years, 31.5, 26.6, and 27.9, respectively.
Recall and negative open surgical biopsy rates are twice as high in US settings than in the United Kingdom but cancer detection rates are similar. Efforts to improve US mammographic screening should target lowering the recall rate without reducing the cancer detection rate.
美国和英国的乳腺钼靶筛查存在差异；直接比较可能会提出改进筛查实践的方法。
比较美国和英国同龄女性的乳腺钼靶筛查效果。
设计、地点和参与者：识别出年龄在50岁及以上的女性，她们在1996年1月1日至1999年12月31日期间，在3个大型乳腺钼靶登记处或筛查项目中接受了550万次乳腺钼靶检查：美国的乳腺癌监测协会（BCSC，n = 978591）和国家乳腺与宫颈癌早期检测项目（NBCCEDP，n = 613388）；以及英国的国民健康服务乳腺筛查项目（NHSBSP，n = 394万）。在这3组中，共有27612名女性在筛查后12个月内被诊断出患有乳腺癌（浸润性癌或导管原位癌）。
计算首次及后续乳腺钼靶检查以及5岁年龄组内的召回率（建议进一步评估，包括诊断性影像学检查、超声检查、临床检查或活检）和癌症检出率。
所有年龄组的召回率在美国约为英国的两倍；然而，癌症检出率相似。在接受首次乳腺钼靶筛查的50至54岁女性中，BCSC组有14.4%、NBCCEDP组有12.5%被召回进一步评估，而NHSBSP组仅为7.6%。每1000次乳腺钼靶筛查的癌症检出率在BCSC组、NBCCEDP组和NHSBSP组中分别为5.8、5.9和6.3。在所有3种情况下，后续检查的召回率较低，但在美国仍为英国的两倍。每种情况下接受活检的女性比例相似，但美国的经皮活检率较低，开放手术活检率较高。在美国，未诊断出癌症的开放手术活检（阴性活检）率是英国的两倍。基于对1000名50至59岁女性进行10年筛查的情况，BCSC组、NBCCEDP组和NHSBSP组分别有477名、433名和175名女性会被召回；对于60至69岁的女性，分别有396名、334名和133名。每1000名50至59岁女性的估计癌症检出率分别为24.5、23.8和19.4，对于60至69岁的女性，分别为31.5、26.6和27.9。
美国的召回率和阴性开放手术活检率是英国的两倍，但癌症检出率相似。改进美国乳腺钼靶筛查的努力应旨在降低召回率，同时不降低癌症检出率。
