加泰罗尼亚乳腺癌死亡率的竞争风险。
Competing risks to breast cancer mortality in Catalonia.
作者信息
Vilaprinyo Ester, Gispert Rosa, Martínez-Alonso Montserrat, Carles Misericòrdia, Pla Roger, Espinàs Josep-Alfons, Rué Montserrat
机构信息
Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Hospitalet de Llobregat Catalonia, Spain.
出版信息
BMC Cancer. 2008 Nov 12;8:331. doi: 10.1186/1471-2407-8-331.
BACKGROUND
Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions.
METHODS
The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death.
RESULTS
There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945-54 in the 40-49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts.
CONCLUSION
We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.
背景
在上个世纪，乳腺癌死亡率发生了重大变化。乳腺癌在存在其他竞争风险的情况下发生，这些风险会影响乳腺癌的发病率和死亡率趋势。本研究的目的是：1）按年龄和出生队列评估西班牙加泰罗尼亚地区乳腺癌死亡对全因死亡率的影响；2）估计除乳腺癌外其他原因导致的死亡风险，这是模拟因筛查或治疗干预导致乳腺癌死亡率降低所需的输入数据之一。
方法
采用多减因生命表方法。首先，按年龄和队列获得全因死亡概率。然后从全因死亡概率中减去乳腺癌死亡概率，以获得除乳腺癌外其他原因的队列生命表。这些生命表一方面提供了死于竞争风险的风险估计，另一方面允许使用除乳腺癌外其他原因的死亡概率与全因死亡概率的比值来评估乳腺癌死亡对全因死亡率的影响。
结果
在20世纪上半叶，乳腺癌对死亡率的影响不断增加，在40 - 49岁年龄组中，1945 - 1954年出生队列的影响达到峰值（该队列约24%的死亡率归因于乳腺癌）。尽管对于1955年以后出生的队列，仅获得了50岁以下女性的信息，但同样值得注意的是，这些队列中乳腺癌对全因死亡率的影响有所下降。
结论
我们已经量化了去除不同年龄组和出生队列中乳腺癌死亡率的影响。我们的结果与美国的研究结果一致。我们还获得了死于竞争原因死亡率的风险估计，这将用于评估加泰罗尼亚地区乳腺钼靶筛查对乳腺癌死亡率影响的评估。
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