Vervoort M M, Draisma G, Fracheboud J, van de Poll-Franse L V, de Koning H J
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, and Netherlands Institute for Health Sciences, The Netherlands.
Br J Cancer. 2004 Jul 19;91(2):242-7. doi: 10.1038/sj.bjc.6601969.
Adjuvant systemic therapy was introduced in the Netherlands as a breast cancer treatment in the early 1980s. In this paper, we describe the trends in the usage of adjuvant systemic treatment in the period 1975-1997 in the Netherlands. The main aim of our study was to assess the effects of adjuvant tamoxifen and polychemotherapy on breast cancer mortality, compared to the effects of the mammography screening programme. The computer simulation model MIcrosimulation SCreening ANalysis, which simulates demography, natural history of breast cancer and screening effects, was used to estimate the effects. Use of adjuvant therapy increased over time, but since 1990 it remained rather stable. Nowadays, adjuvant therapy is given to 88% of node-positive patients aged 50-69 years, while less than 10% of node-negative patients receive any kind of adjuvant treatment. Adjuvant treatment is given independent of the mode of detection (adjusted by nodal status and size). We predict that the reduction in breast cancer mortality due to adjuvant therapy is 7% in women aged 55-74 years, while the reduction due to screening, which was first implemented in women aged 50-69 years in 1990-97, will be 28-30% in 2007. In conclusion, although adjuvant systemic therapy can reduce breast cancer mortality rates, it is anticipated to be less than the mortality reduction caused by mammography screening.
20世纪80年代初，辅助性全身治疗作为一种乳腺癌治疗方法在荷兰被引入。在本文中，我们描述了1975年至1997年期间荷兰辅助性全身治疗的使用趋势。我们研究的主要目的是评估辅助性他莫昔芬和多药化疗对乳腺癌死亡率的影响，并与乳腺钼靶筛查计划的效果进行比较。使用模拟人口统计学、乳腺癌自然史和筛查效果的计算机模拟模型MIcrosimulation SCreening ANalysis来估计效果。辅助治疗的使用随时间增加，但自1990年以来一直相当稳定。如今，88%的50至69岁淋巴结阳性患者接受辅助治疗，而不到10%的淋巴结阴性患者接受任何形式的辅助治疗。辅助治疗的给予与检测方式无关（根据淋巴结状态和大小进行调整）。我们预测，55至74岁女性因辅助治疗导致的乳腺癌死亡率降低7%，而筛查（1990年至1997年首次在50至69岁女性中实施）导致的死亡率降低在2007年将为28%至30%。总之，尽管辅助性全身治疗可以降低乳腺癌死亡率，但预计其降低幅度小于乳腺钼靶筛查导致的死亡率降低幅度。
