Cronin-Fenton Deirdre P, Ries Lynn A, Clegg Limin X, Edwards Brenda K
Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
J Natl Cancer Inst. 2007 Jul 4;99(13):1044-9. doi: 10.1093/jnci/djm026. Epub 2007 Jun 27.
We investigated the increased incidence of early-stage breast cancer with micrometastatic lymph node involvement. Breast cancer incidence trends from 1990 through 2002 in the US Surveillance, Epidemiology, and End Results Program catchment area were analyzed. Joinpoint regression was used to show the annual percentage change (APC) in breast cancer incidence trends. The overall incidence of breast cancer among women aged 50-64 years increased 1.8% (95% confidence interval [CI] = 1.4% to 2.2%) per annum from 1990 through 2002 but decreased in all other age groups. Stage IIA and stage IIB tumor incidence increased (APC for stage IIA from 1996 to 2002 = 61.9%, 95% CI = 51.1% to 73.4%, and APC for stage IIB from 1998 to 2002 = 53.7%, 95% CI = 20.6% to 96.0%). The incidence of micrometastatic lymph node involvement for stage IIA and stage IIB tumors increased during the 1990s, especially after 1997 (APC = 17.3% for both stages), more for estrogen receptor-positive than estrogen receptor-negative disease. Increased use of mammography screening partly explains the increased incidence of early-stage breast cancer. Increases in small tumors with micrometastatic lymph node involvement may be attributable to the increased use of the sentinel lymph node biopsy in community practice.
我们调查了伴有微转移淋巴结受累的早期乳腺癌发病率上升情况。分析了美国监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results Program）覆盖地区1990年至2002年的乳腺癌发病率趋势。采用连接点回归分析来显示乳腺癌发病率趋势的年度百分比变化（APC）。1990年至2002年期间，50 - 64岁女性的乳腺癌总体发病率每年上升1.8%（95%置信区间[CI]=1.4%至2.2%），但其他所有年龄组的发病率均有所下降。IIA期和IIB期肿瘤的发病率上升（1996年至2002年IIA期的APC = 61.9%，95% CI = 51.1%至73.4%；1998年至2002年IIB期的APC = 53.7%，95% CI = 20.6%至96.0%）。20世纪90年代，尤其是1997年之后，IIA期和IIB期肿瘤微转移淋巴结受累的发病率上升（两个阶段的APC均为17.3%），雌激素受体阳性疾病的上升幅度大于雌激素受体阴性疾病。乳腺钼靶筛查使用的增加部分解释了早期乳腺癌发病率的上升。伴有微转移淋巴结受累的小肿瘤发病率增加可能归因于社区实践中前哨淋巴结活检使用的增加。
