Lash Timothy L, Fox Matthew P, Buist Diana S M, Wei Feifei, Field Terry S, Frost Floyd J, Geiger Ann M, Quinn Virginia P, Yood Marianne Ulcickas, Silliman Rebecca A
Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
J Clin Oncol. 2007 Jul 20;25(21):3001-6. doi: 10.1200/JCO.2006.09.9572. Epub 2007 Jun 4.
There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up.
We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality.
One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group.
Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.
如今美国有超过200万乳腺癌幸存者。虽然对无症状复发和第二原发性肿瘤的监测已纳入共识建议，但这种监测的有效性尚未得到充分描述。我们的目的是在一组乳腺癌幸存者中评估监测性乳房X光检查的有效性，这些幸存者的监测性乳房X光检查已完全确定，且随访损失可忽略不计。
我们在六个综合医疗保健系统中招募了1846例I期和II期乳腺癌患者，这些患者年龄至少65岁。我们通过病历审查和现有数据库来确定患者、肿瘤和治疗特征，以及监测性乳房X光检查的接受情况。我们将个人标识符与国家死亡指数相链接，以确定死亡日期和死因。我们为每位乳腺癌死亡患者匹配了四名对照，以评估接受监测性乳房X光检查与乳腺癌死亡率之间的关联。
在5年的随访期间，有178名女性死于乳腺癌。每增加一次监测性乳房X光检查，乳腺癌死亡几率就会降低0.69倍（95%置信区间，0.52至0.92）。这种保护关联在I期疾病患者、接受乳房切除术的患者以及年龄最大的年龄组中最为明显。
鉴于现有关于治疗后监测的建议，比较监测与不监测的试验不太可能进行。这项大型观察性研究为这些建议提供了支持，表明接受监测性乳房X光检查可降低早期疾病诊断的老年患者的乳腺癌死亡率。
