McCormack Valerie A, dos Santos Silva Isabel
Non-communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1159-69. doi: 10.1158/1055-9965.EPI-06-0034.
Mammographic features are associated with breast cancer risk, but estimates of the strength of the association vary markedly between studies, and it is uncertain whether the association is modified by other risk factors. We conducted a systematic review and meta-analysis of publications on mammographic patterns in relation to breast cancer risk. Random effects models were used to combine study-specific relative risks. Aggregate data for > 14,000 cases and 226,000 noncases from 42 studies were included. Associations were consistent in studies conducted in the general population but were highly heterogeneous in symptomatic populations. They were much stronger for percentage density than for Wolfe grade or Breast Imaging Reporting and Data System classification and were 20% to 30% stronger in studies of incident than of prevalent cancer. No differences were observed by age/menopausal status at mammography or by ethnicity. For percentage density measured using prediagnostic mammograms, combined relative risks of incident breast cancer in the general population were 1.79 (95% confidence interval, 1.48-2.16), 2.11 (1.70-2.63), 2.92 (2.49-3.42), and 4.64 (3.64-5.91) for categories 5% to 24%, 25% to 49%, 50% to 74%, and > or = 75% relative to < 5%. This association remained strong after excluding cancers diagnosed in the first-year postmammography. This review explains some of the heterogeneity in associations of breast density with breast cancer risk and shows that, in well-conducted studies, this is one of the strongest risk factors for breast cancer. It also refutes the suggestion that the association is an artifact of masking bias or that it is only present in a restricted age range.
乳腺钼靶特征与乳腺癌风险相关，但不同研究对这种关联强度的估计差异显著，且这种关联是否会受到其他风险因素的影响尚不确定。我们对有关乳腺钼靶影像模式与乳腺癌风险的出版物进行了系统综述和荟萃分析。采用随机效应模型合并各研究的相对风险。纳入了来自42项研究的超过14,000例病例和226,000例对照的汇总数据。在一般人群中开展的研究中，关联是一致的，但在有症状人群中存在高度异质性。百分比密度的关联比沃尔夫分级或乳腺影像报告和数据系统分类更强，且在新发癌症研究中的关联比现患癌症研究强20%至30%。在钼靶检查时的年龄/绝经状态或种族方面未观察到差异。对于使用诊断前钼靶片测量的百分比密度，一般人群中新发乳腺癌的合并相对风险在5%至24%、25%至49%、50%至74%以及≥75%类别中分别为1.79（95%置信区间，1.48 - 2.16）、2.11（1.70 - 2.63）、2.92（2.49 - 3.42）和4.64（3.64 - 5.91），相对于＜5%的类别。排除钼靶检查后第一年诊断出的癌症后，这种关联仍然很强。本综述解释了乳腺密度与乳腺癌风险关联中的一些异质性，并表明在开展良好的研究中，这是最强的乳腺癌风险因素之一。它还反驳了这种关联是掩盖偏倚的假象或仅存在于特定年龄范围内的观点。
