Schonberg Mara A, Silliman Rebecca A, Marcantonio Edward R
Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02446, USA.
J Clin Oncol. 2009 Apr 10;27(11):1774-80. doi: 10.1200/JCO.2008.19.9877. Epub 2009 Mar 2.
To examine outcomes of mammography screening among women > or = 80 years to inform decision making.
We conducted a cohort study of 2,011 women without a history of breast cancer who were age > or = 80 years between 1994 and 2004 and who received care at one academic primary care clinic or two community health centers in Boston, MA. Medical record data were abstracted on all screening and diagnostic mammograms, breast ultrasounds and biopsies performed, all breast cancers diagnosed through December 31, 2006, and on sociodemographics. Date and cause of death were confirmed using the National Death Index.
The majority of patients (78.6%) were non-Hispanic white and 51.4% (n = 1,034) had been screened with mammography since age 80 years. Among women who were screened, eight were diagnosed with ductal carcinoma in situ, 16 with early stage disease (1.5%), two with late stage disease, and one died as a result of breast cancer. Many (110; 11%) experienced a false-positive screening mammogram that led to 19 benign breast biopsies, eight refused work-up, and three experienced a false-negative screening mammogram; 97 were screened within 2 years of their death from other causes. There were no significant differences in the rate, stage, recurrence rate, or deaths due to breast cancer between women who were screened and those who were not screened.
The majority of women > or = 80 years are screened with mammography yet few benefit. Meanwhile, 12.5% experience a burden from screening. The data from this study can be used to inform elderly women's decision making and potentially lead to more rational use of screening.
研究80岁及以上女性的乳房X线筛查结果，为决策提供依据。
我们对2011名无乳腺癌病史的女性进行了队列研究，这些女性在1994年至2004年间年龄≥80岁，且在马萨诸塞州波士顿的一家学术初级保健诊所或两家社区卫生中心接受治疗。提取了所有筛查和诊断性乳房X线照片、乳房超声检查和活检、截至2006年12月31日诊断出的所有乳腺癌以及社会人口统计学数据的病历资料。使用国家死亡指数确认死亡日期和原因。
大多数患者（78.6%）为非西班牙裔白人，51.4%（n = 1034）自80岁起接受过乳房X线筛查。在接受筛查的女性中，8例被诊断为导管原位癌，16例为早期疾病（1.5%），2例为晚期疾病，1例死于乳腺癌。许多人（110例；11%）乳房X线筛查结果为假阳性，导致19例进行了良性乳房活检，8例拒绝进一步检查，3例筛查结果为假阴性；97例在因其他原因死亡前2年内接受了筛查。筛查组和未筛查组在乳腺癌的发病率、分期、复发率或死亡率方面无显著差异。
大多数80岁及以上的女性接受了乳房X线筛查，但受益的人很少。与此同时，12.5%的人承受了筛查带来的负担。本研究的数据可用于为老年女性的决策提供依据，并可能导致更合理地使用筛查。
