Taplin Stephen H, Ichikawa Laura, Buist Diana S M, Seger Deborah, White Emily
Center for Health Studies, Group Health Cooperative, Seattle, Washington, USA.
Cancer Epidemiol Biomarkers Prev. 2004 Feb;13(2):225-34. doi: 10.1158/1055-9965.epi-03-0206.
The objective of our study was to evaluate organized breast cancer screening implementation by measuring the association between screening program enrollment and late-stage disease. Our setting was a health plan using mailed mammography reminders to women ages > or = 40. We conducted yearly cross-sectional summaries of mammography experience and late-stage (regional or distant Surveillance Epidemiology and End Results Reporting (SEER) stage) breast cancer occurrence for all of the health-plan women ages > or = 40 (1986-1998). We estimated the odds of late-stage breast cancer among health-plan and surrounding community women because it was too early to compare changes in mortality. We also estimated the odds of late-stage disease (1995-1998) associated with program enrollment and mammography screening among health-plan women. We found that mammography-within-two-years increased within the health plan from 25.9% to 51.2% among women ages 40-49 and from 32.9% to 74.7% among women ages> or = 50. Health-plan late-stage rates were lower than those in the surrounding community [ages 40-49: odds ratio (OR), 0.87; 95% confidence interval (CI), 0.77-0.99; ages 50-79: OR, 0.86; 95% CI, 0.80-0.92] and declined parallel to the community. Among health-plan cancer cases, women ages > or = 43 who were enrolled in the screening program and who had at least one program mammogram were less likely to have late-stage disease compared with the women not enrolled in the program (OR, 0.31; 95% CI, 0.16-0.61) but the odds of late-stage was also reduced among program-enrolled women not receiving program mammograms (OR, 0.45; 95% CI, 0.21-0.95). We concluded that enrollment in organized screening is associated with increased likelihood of mammography and reduced odds of late-stage breast cancer. Addressing the concerns of un-enrolled women and those without mammograms offers an opportunity for further late-stage disease reduction.
我们研究的目的是通过衡量筛查项目登记情况与晚期疾病之间的关联，来评估有组织的乳腺癌筛查实施情况。我们的研究背景是一个健康计划，该计划向年龄大于或等于40岁的女性邮寄乳房X光检查提醒。我们对所有年龄大于或等于40岁（1986 - 1998年）的健康计划女性的乳房X光检查经历和晚期（区域或远处监测、流行病学和最终结果报告（SEER）阶段）乳腺癌发生情况进行了年度横断面总结。由于比较死亡率变化还为时过早，我们估计了健康计划女性和周边社区女性患晚期乳腺癌的几率。我们还估计了健康计划女性中与项目登记和乳房X光检查相关的晚期疾病（1995 - 1998年）几率。我们发现，在健康计划中，40 - 49岁女性两年内进行乳房X光检查的比例从25.9%增至51.2%，年龄大于或等于50岁的女性从32.9%增至74.7%。健康计划中的晚期发病率低于周边社区[40 - 49岁：优势比（OR），0.87；95%置信区间（CI），0.77 - 0.99；50 - 79岁：OR，0.86；95% CI，0.80 - 0.92]，且与社区发病率平行下降。在健康计划的癌症病例中，年龄大于或等于43岁且登记参加筛查项目并至少进行过一次项目乳房X光检查的女性，与未登记参加项目的女性相比，患晚期疾病的可能性较小（OR，0.31；95% CI，0.16 - 0.61），但在登记参加项目但未接受项目乳房X光检查的女性中，晚期疾病的几率也有所降低（OR，0.45；95% CI，0.21 - 0.95）。我们得出结论，参加有组织的筛查与乳房X光检查可能性增加以及晚期乳腺癌几率降低相关。解决未登记女性和未进行乳房X光检查女性的担忧为进一步降低晚期疾病提供了机会。
