Paci Eugenio, Ponti Antonio, Zappa Marco, Patriarca Silvia, Falini Patrizia, Delmastro Gabriella, Bianchi Simonetta, Sapino Anna, Vezzosi Vania, Senore Carlo, Crocetti Emanuele, Frigerio Alfonso, Zanetti Roberto, Del Turco Marco Rosselli, Segnan Nereo
Unit of Clinical and Descriptive Epidemiology, Centre for Study and Prevention of Cancer, Research Institute of Tuscany Region, Via di San Salvi 12, 50125 Firenze, Florence, Italy.
Eur J Cancer. 2005 Nov;41(17):2728-34. doi: 10.1016/j.ejca.2005.06.026. Epub 2005 Oct 18.
Italian population-based breast cancer screening programmes with 2-year, high-quality mammography started in the cities of Florence and Turin in the early 1990s. Breast cancer cases from the local Tumour Registry were classified by method of detection and tumour characteristics (size, nodal-status and grade). Follow-up was at December 2001. In total, 4444 breast cancer cases were analysed. The Hazard Ratio comparing before and after-invitation breast cancer cases indicated a 27% reduction (HR=0.73; 95%CI: 0.61-0.87) in the risk of dying for the disease. After adjustment for tumour characteristics, survival rate was comparable by invitation status, whereas the proportion of early cancer was 33.7% and 46.6% in the before and after-invitation group. Survival rates by tumour characteristic subgroups was comparable by invitation status. Late stage and grade 3 were indicators of poor prognosis. Adjustment for tumour characteristics confirmed screening and not differential treatment as the most important reason for the observed survival benefit. The survival analysis by specific subgroups did not support the hypothesis that the difference in prognosis was attributable to differential treatment.
20世纪90年代初，意大利在佛罗伦萨和都灵市启动了基于人群的乳腺癌筛查项目，采用为期两年的高质量乳房X光检查。当地肿瘤登记处的乳腺癌病例按检测方法和肿瘤特征（大小、淋巴结状态和分级）进行分类。随访截至2001年12月。总共分析了4444例乳腺癌病例。比较受邀前后乳腺癌病例的风险比表明，该病死亡风险降低了27%（风险比=0.73；95%置信区间：0.61-0.87）。在对肿瘤特征进行调整后，按受邀状态划分的生存率具有可比性，而早期癌症的比例在受邀前组和受邀后组分别为33.7%和46.6%。按肿瘤特征亚组划分的生存率按受邀状态具有可比性。晚期和3级是预后不良的指标。对肿瘤特征进行调整后证实，筛查而非差异治疗是观察到生存获益的最重要原因。特定亚组的生存分析不支持预后差异归因于差异治疗这一假设。
