Allgood P C, Warwick J, Warren R M L, Day N E, Duffy S W
Cancer Research UK Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK.
Br J Cancer. 2008 Jan 15;98(1):206-9. doi: 10.1038/sj.bjc.6604123. Epub 2007 Dec 4.
Although breast cancer screening has been shown to work in randomised trials, there is a need to evaluate service screening programmes to ensure that they are delivering the benefit indicated by the trials. We carried out a case-control study to investigate the effect of mammography service screening, in the NHS breast screening programme, on breast cancer mortality in the East Anglian region of the UK. Cases were deaths from breast cancer in women diagnosed between the ages of 50 and 70 years, following the instigation of the East Anglia Breast Screening Programme in 1989. The controls were women (two per case) who had not died of breast cancer, from the same area, matched by date of birth to the cases. Each control was known to be alive at the time of death of her matched case. All women were known to the breast screening programme and were invited, at least once, to be screened. There were 284 cases and 568 controls. The odds ratio (OR) for risk of death from breast cancer in women who attended at least one routine screen compared to those who did not attend was 0.35 (CI: 0.24, 0.50). Adjusting for self-selection bias gave an estimate of the breast cancer mortality reduction associated with invitation to screening of 35% (OR=0.65, 95% CI: 0.48, 0.88). The effect of actually being screened was a 48% breast cancer mortality reduction (OR=0.52, 95% CI: 0.32, 0.84). The results suggest that the National Breast Screening Programme in East Anglia is achieving a reduction in breast cancer deaths, which is at least consistent with the results from the randomised controlled trials of mammographic screening.
尽管乳腺癌筛查在随机试验中已被证明有效，但仍有必要评估服务筛查项目，以确保其能带来试验所表明的益处。我们开展了一项病例对照研究，以调查英国国家医疗服务体系（NHS）乳房筛查项目中乳房X光检查服务筛查对英国东安格利亚地区乳腺癌死亡率的影响。病例为1989年东安格利亚乳房筛查项目启动后，年龄在50至70岁之间被诊断为乳腺癌的女性死亡病例。对照为来自同一地区、未死于乳腺癌的女性（每例病例对应两名对照），按出生日期与病例匹配。已知每名对照在其匹配病例死亡时仍在世。所有女性均在乳房筛查项目登记在册，且至少被邀请过一次进行筛查。共有284例病例和568名对照。与未参加过至少一次常规筛查的女性相比，参加过至少一次常规筛查的女性死于乳腺癌的风险比（OR）为0.35（置信区间：0.24，0.50）。调整自我选择偏倚后，估计与受邀筛查相关的乳腺癌死亡率降低了35%（OR = 0.65，95%置信区间：0.48，0.88）。实际接受筛查的效果是乳腺癌死亡率降低了48%（OR = 0.52，95%置信区间：0.32，0.84）。结果表明，东安格利亚的国家乳房筛查项目正在降低乳腺癌死亡率，这至少与乳房X光检查筛查的随机对照试验结果一致。
