Luke Colin, Priest Kevin, Roder David
The Cancer Council, South Australia, PO Box 929, Unley, SA 5061, Australia.
Asian Pac J Cancer Prev. 2006 Jan-Mar;7(1):69-74.
To investigate secular trends and correlates of incidence of breast cancer by histology type following the introduction of population-based mammography screening.
Analysis of age-standardised incidence rates for 1,423 in situ and 16,157 invasive carcinomas recorded on the South Australian population-based cancer registry for the 1985-2004 diagnostic period. Multiple logistic regression was undertaken to compare socio-demographic characteristics by histology. Progression from in situ disease was investigated using the Kaplan-Meier method.
The incidence of in situ lesions increased approximately seven-fold over the 20-year period, compared with an increase of about 40% for invasive cancers. The increase for in situ lesions was due to increases for ductal carcinomas, with little change for lobular lesions. By comparison, the percentage increase in incidence for invasive cancer was greater for lobular than ductal cancers. Both for in situ and invasive cancers, percentage increases were greatest for the screening target age range of 50-69 years. One in 14 in situ cases was found to progress to invasive cancer within seven years of diagnosis, but insufficient detail was available to determine whether the invasive cancers were a progression of the in situ lesions or whether they originated separately. These invasive cancers were smaller than generally applying for other invasive cancers of the female breast.
The larger secular increases in incidence for in situ than invasive cancers would reflect the dominant role of mammography in the detection of ductal carcinoma in situ. The lack of an increase for lobular in situ lesions may have resulted from their poorer radiological visibility. The greater percentage increase for lobular than ductal invasive lesions may have been due to an increase in imaging sensitivity for these lesions, plus real increases in incidence. The smaller sizes of invasive cancers found in women with a prior in situ diagnosis may have resulted from more intensive medical surveillance, although the possibility of biological differences cannot be discounted.
在引入基于人群的乳腺钼靶筛查后，研究乳腺癌组织学类型的长期趋势及其发病率的相关因素。
分析1985 - 2004年诊断期间南澳大利亚基于人群的癌症登记处记录的1423例原位癌和16157例浸润性癌的年龄标准化发病率。采用多因素logistic回归按组织学比较社会人口学特征。使用Kaplan-Meier方法研究原位疾病的进展情况。
在20年期间，原位病变的发病率增加了约7倍，而浸润性癌增加了约40%。原位病变的增加是由于导管癌的增加，小叶病变变化不大。相比之下，浸润性癌中，小叶癌的发病率增加百分比高于导管癌。对于原位癌和浸润性癌，在筛查目标年龄范围50 - 69岁时发病率增加百分比最大。发现14例原位病例中有1例在诊断后7年内进展为浸润性癌，但没有足够详细信息来确定这些浸润性癌是原位病变的进展还是单独起源。这些浸润性癌比女性乳腺其他浸润性癌通常的情况要小。
原位癌发病率的长期增长幅度大于浸润性癌，这反映了乳腺钼靶在检测导管原位癌中的主导作用。小叶原位病变发病率未增加可能是由于其在放射学上可见性较差。小叶浸润性病变的发病率增加百分比高于导管浸润性病变，可能是由于这些病变的成像敏感性增加以及实际发病率上升。先前诊断为原位癌的女性中发现的浸润性癌尺寸较小，可能是由于更密集的医学监测，尽管生物学差异的可能性也不能排除。
