Allemand Hubert, Seradour Brigitte, Weill Alain, Ricordeau Philippe
CNAMTS (Caisse nationale d'assurance-maladie des travailleurs salariés), 50, avenue du Pr André-Lemierre, 75986 Paris Cedex 20, France.
Bull Cancer. 2008 Jan;95(1):11-5. doi: 10.1684/bdc.2008.0556.
The objective of this paper is to measure breast cancer incidence rates between 2000 and 2006, and to analyse during this period the changes in mammographic screening and in the use of hormone-replacement therapy (HRT). Incidence rates were calculated from the new cases of breast cancers among affiliates of the general schema of the national health fund who received first time approval for their long-term disorder. We obtained the trends in HRT use and in mammographic screening from the database of the health fund and from the National Institute for Public Health Surveillance. Between 2000 and 2004, the increase in the annual age adjusted incidence of breast cancer was 2.1 %. Decline in breast cancer incidence was 4.3 % between 2004 and 2005, and 3 % between 2005 and 2006. During this period, the decrease was evident only among women who were 50 years of age or older: the decline was 6 % between 2004 and 2005 and 5.3 % between 2005 and 2006. Between 2000 and 2006, the annual rates of HRT use declined by 62 % and organized screening mammography increased by 335 %. The observation of a decline in breast cancer incidence during the implementation of a screening programme is a paradox. The concomitant and dramatic reduction in the use of HRT is the only major environmental change to explain this trend.
本文的目的是测量2000年至2006年期间的乳腺癌发病率，并分析在此期间乳房X线筛查和激素替代疗法（HRT）使用情况的变化。发病率是根据国家健康基金一般方案附属机构中首次获得长期疾病批准的乳腺癌新病例计算得出的。我们从健康基金数据库和国家公共卫生监测研究所获得了HRT使用情况和乳房X线筛查的趋势。2000年至2004年期间，年龄调整后的乳腺癌年发病率上升了2.1%。2004年至2005年期间乳腺癌发病率下降了4.3%，2005年至2006年期间下降了3%。在此期间，下降仅在50岁及以上的女性中明显：2004年至2005年期间下降了6%，2005年至2006年期间下降了5.3%。2000年至2006年期间，HRT的年使用率下降了62%，而有组织的乳房X线筛查增加了335%。在实施筛查计划期间观察到乳腺癌发病率下降是一个悖论。HRT使用的同时大幅减少是解释这一趋势的唯一主要环境变化。
