Georgetown University Medical Center and Lombardi Comprehensive Cancer Center, Washington, DC, USA.
Ann Intern Med. 2009 Nov 17;151(10):738-47. doi: 10.7326/0003-4819-151-10-200911170-00010.
Despite trials of mammography and widespread use, optimal screening policy is controversial.
To evaluate U.S. breast cancer screening strategies.
6 models using common data elements.
National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects.
A contemporary population cohort.
Lifetime.
Societal.
20 screening strategies with varying initiation and cessation ages applied annually or biennially.
Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. no screening), false-positive results, unnecessary biopsies, and overdiagnosis.
RESULTS OF BASE-CASE ANALYSIS: The 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages.
Varying test sensitivity or treatment patterns did not change conclusions.
Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment.
Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations.
National Cancer Institute.
尽管进行了乳房 X 光检查试验和广泛应用，但最佳筛查政策仍存在争议。
评估美国的乳腺癌筛查策略。
使用常见数据元素的 6 种模型。
特定年龄段发病率、竞争死亡率、乳房 X 光特征和治疗效果的国家数据。
当代人群队列。
终身。
社会视角。
20 种不同起始和终止年龄的筛查策略，每年或每两年应用一次。
乳房 X 光检查的数量、乳腺癌死亡或生命年数的减少（与不筛查相比）、假阳性结果、不必要的活检和过度诊断。
6 种模型对筛查策略的排名一致。每两年筛查一次可维持年度筛查的平均 81%（策略和模型之间的范围为 67%至 99%），假阳性结果的数量几乎减少一半。从 50 岁至 69 岁开始每两年筛查一次，与不筛查相比，乳腺癌死亡人数中位数减少 16.5%（范围为 15%至 23%）。将起始每两年筛查的年龄从 50 岁提前到 40 岁，可使死亡率进一步降低 3%（范围为 1%至 6%），消耗更多资源，并产生更多的假阳性结果。在所有模型中，69 岁以后每两年筛查一次可进一步降低死亡率，但随着年龄的增长，过度诊断的增加幅度最大。
检测敏感性或治疗模式的变化并未改变结论。
结果不包括假阳性结果的发病率、患者对早期诊断的认识或不必要的治疗。
每两年筛查可获得与每年筛查相似的大部分益处，而危害较小。最佳策略的决策取决于计划和个人目标以及对益处、危害和资源考虑的重视程度。
美国国家癌症研究所。
