Narod Steven A, Lubinski Jan, Ghadirian Parviz, Lynch Henry T, Moller Pal, Foulkes William D, Rosen Barry, Kim-Sing Charmaine, Isaacs Claudine, Domchek Susan, Sun Ping
Centre for Research on Women's Health, University of Toronto, Ontario, Canada.
Lancet Oncol. 2006 May;7(5):402-6. doi: 10.1016/S1470-2045(06)70624-6.
Screening mammography is associated with a small dose of radiation to the breast, and women with increased genetic risk might be particularly sensitive to the DNA-damaging effects of ionising radiation. We aimed to assess whether exposure to ionising radiation through mammography screening was associated with risk of breast cancer in BRCA1 or BRCA2 mutation carriers.
We identified 1600 cases of breast cancer and 1600 controls without breast cancer who were matched for BRCA mutation, date of birth (within 1 year), and country of residence from an international registry of BRCA1 and BRCA2 mutation carriers. We used a questionnaire to inquire about whether participants had ever had screening mammography, and, if so, the age at which they first had the procedure.
We found no association between ever having screening mammography and risk of breast cancer (odds ratio [OR] 1.03 [95% CI 0.85-1.25], adjusted for parity, oral-contraceptive use, ethnic origin, and bilateral oophorectomy). The association was much the same for BRCA1 mutation carriers and BRCA2 mutation carriers (1.04 [0.84-1.29] vs 1.06 [0.67-1.66], respectively, adjusted for parity, oral-contraceptive use, ethnic origin, and bilateral oophorectomy).
These findings do not lend support to the idea that exposure to ionising radiation through routine screening mammography contributes substantially to the burden of breast cancer in BRCA1 and BRCA2 mutation carriers. Prospective studies are needed to confirm the results of this initial report, and, where possible, these studies should assess a more appropriate endpoint of total exposure.
乳腺钼靶筛查会使乳房受到少量辐射，而遗传风险增加的女性可能对电离辐射的DNA损伤效应尤为敏感。我们旨在评估通过乳腺钼靶筛查接触电离辐射是否与BRCA1或BRCA2突变携带者患乳腺癌的风险相关。
我们从一个BRCA1和BRCA2突变携带者国际登记处中，确定了1600例乳腺癌病例和1600例无乳腺癌的对照者，这些对照者在BRCA突变、出生日期（1年内）和居住国家方面进行了匹配。我们使用问卷询问参与者是否曾接受过乳腺钼靶筛查，如果是，他们首次进行该检查的年龄。
我们发现，曾经接受乳腺钼靶筛查与患乳腺癌的风险之间没有关联（比值比[OR]为1.03[95%置信区间0.85 - 1.25]，对胎次、口服避孕药使用情况、种族和双侧卵巢切除术进行了调整）。BRCA1突变携带者和BRCA2突变携带者的关联情况大致相同（分别为1.04[0.84 - 1.29]和1.06[0.67 - 1.66]，对胎次、口服避孕药使用情况、种族和双侧卵巢切除术进行了调整）。
这些发现不支持通过常规乳腺钼靶筛查接触电离辐射会显著增加BRCA1和BRCA2突变携带者乳腺癌负担这一观点。需要进行前瞻性研究来证实这份初步报告的结果，并且在可能的情况下，这些研究应评估更合适的总暴露终点。
