Pérez-Fidalgo Jose Alejandro, Miranda Josefa, Chirivella Isabel, Ibáñez Josefa, Bermejo Begona, Pons Carmen, Melchor Inmaculada, Santaballa Ana, Martínez-Ruiz Francisco, Lluch Ana, Salas Dolores
Oncology and Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Clin Transl Oncol. 2008 Nov;10(11):745-52. doi: 10.1007/s12094-008-0281-y.
Randomised clinical trials with a control arm of non-screened patients are nowadays ethically impossible. The aim of this study was to establish the impact of mammography screening on a non-selected population.
Between January 1993 and December 2002, 3662 patients were included, 2313 in the screened group and 1349 in the unscreened group.
55.3% of the screened patients were diagnosed in stage I vs. 26.1% in the non-screened group. The proportion of stage III-IV was 4.6% and 19.8% for the screened and unscreened groups respectively (p<0.001). 48.8% in the screening group were submitted to mastectomy vs. 66.4% of the unscreened patients (p<0.001). Overall survival was superior for the prevalent cases in the screening group, with a relative risk of 0.49, and was not significant for the incident cases.
Diagnosis of breast cancer in the mammography screening programme of the Region of Valencia significantly increases conservative surgery rates and suggests an improvement in survival in prevalent cases. The increased rate of early stages in these patients could be the main reason of this benefit.
如今，设立未接受筛查患者作为对照组的随机临床试验在伦理上是不可能的。本研究的目的是确定乳腺钼靶筛查对未经过选择的人群的影响。
1993年1月至2002年12月期间，纳入了3662例患者，其中筛查组2313例，未筛查组1349例。
筛查组55.3%的患者诊断为I期，而未筛查组为26.1%。筛查组和未筛查组III-IV期的比例分别为4.6%和19.8%（p<0.001）。筛查组48.8%的患者接受了乳房切除术，而未筛查组为66.4%（p<0.001）。筛查组中现患病例的总生存率更高，相对风险为0.49，而新发病例的总生存率无显著差异。
在瓦伦西亚地区的乳腺钼靶筛查项目中，乳腺癌的诊断显著提高了保乳手术率，并提示现患病例的生存率有所改善。这些患者早期阶段比例的增加可能是这种益处的主要原因。
