Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
Cancer Causes Control. 2010 Jan;21(1):147-52. doi: 10.1007/s10552-009-9444-6. Epub 2009 Oct 21.
The recent decline in US breast cancer incidence rates has been attributed to the marked reduction in use of postmenopausal hormone therapy (HT). An alternative explanation is that women who are not routinely seeking medical care to renew HT prescriptions may be less adherent to recommendations for mammographic screening. To investigate the latter possibility, we compared mammographic intervals according to HT use.
Using data (1995-2007) from the New Hampshire Mammography Network (NHMN), a state-based mammography registry, we assessed mammographic intervals corresponding to HT use or nonuse among postmenopausal women. We used linear mixed effects models to assess whether the length of screening mammogram intervals differed according to HT use.
A total of 310,185 mammograms, representing 76,192 postmenopausal women and 319,353 person-years of screening, were included in the analysis. The median screening interval corresponding to HT use overall was 13.0 months (interquartile range: 12.4-15.1) and for nonuse was 13.1 (interquartile range: 12.4-15.8). Virtually, all screening mammograms occurred within a 2-year interval regardless of HT use or nonuse (98.5 and 98.1%, respectively).
Our findings indicate that screening mammography intervals are similar whether or not women are using HT. Thus, reduced utilization of screening mammography is unlikely to account for the decrease in breast cancer incidence seen soon after the WHI report.
美国乳腺癌发病率的近期下降归因于绝经后激素治疗(HT)的使用明显减少。另一种解释是,那些没有定期寻求医疗服务来更新 HT 处方的女性可能不太遵守乳房 X 光筛查的建议。为了探究后一种可能性,我们比较了根据 HT 使用情况的乳房 X 光检查间隔。
利用新罕布什尔州乳腺摄影网络(NHMN)的数据(1995-2007 年),这是一个基于州的乳腺摄影登记处,我们评估了绝经后女性中 HT 使用或不使用时对应的乳房 X 光检查间隔。我们使用线性混合效应模型来评估根据 HT 使用情况,筛查乳房 X 光检查间隔的长度是否存在差异。
共纳入 310185 次乳房 X 光检查,代表 76192 名绝经后女性和 319353 人年的筛查,分析中包括这些数据。总体上,HT 使用对应的中位筛查间隔为 13.0 个月(四分位间距:12.4-15.1),不使用 HT 对应的中位筛查间隔为 13.1 个月(四分位间距:12.4-15.8)。无论是否使用 HT,几乎所有的筛查乳房 X 光检查都在 2 年内进行(分别为 98.5%和 98.1%)。
我们的研究结果表明,是否使用 HT,筛查乳房 X 光检查的间隔相似。因此,筛查乳房 X 光检查利用率的降低不太可能解释 WHI 报告发布后不久乳腺癌发病率的下降。