Kalager Mette, Kåresen Rolf, Wist Erik
Kreftregisteret, Postboks 5313, Majorstuen, 0303 Oslo, Norway.
Tidsskr Nor Laegeforen. 2009 Dec 17;129(24):2595-600. doi: 10.4045/tidsskr.09.0024.
A major goal in Norwegian health politics is that all patients should have equal access to health services irrespective of where they live. Different access to health services may affect prognosis. Breast cancer is the most common type of cancer among Norwegian women. In this article we analyse breast cancer survival by Norwegian county.
Population-based study including all Norwegian women diagnosed with breast cancer between 1985 and 2004. Breast cancer survival was analysed by county using Cox proportional hazards models.
41,833 women with breast cancer were included in the study. After a median follow-up time of 5.8 years, 16,494 (39.4 %) women died; 9953 (60.3 %) of them of breast cancer. Five-year breast cancer specific survival varied from 74.1 to 80.6 % in the different counties. Age-adjusted analyses that excluded women invited to mammography screening, showed a 20 % difference in breast cancer survival (HR 0.80; 95 %KI 0.72-0.90; p < 0.001) between the counties. For women diagnosed with tumours in stage two, the difference was 45 %. Treatment varied between counties, but the treatment trends were similar in the different counties during the study period.
There is a significant difference in breast cancer survival between Norwegian counties. Possible explanations may be differences in offering of mammography screening, diagnostics and treatment.
挪威卫生政策的一个主要目标是，所有患者无论居住在何处，都应平等获得医疗服务。获得医疗服务的差异可能会影响预后。乳腺癌是挪威女性中最常见的癌症类型。在本文中，我们按挪威郡县分析乳腺癌生存率。
基于人群的研究，纳入1985年至2004年间所有被诊断为乳腺癌的挪威女性。使用Cox比例风险模型按郡县分析乳腺癌生存率。
41833名乳腺癌女性纳入研究。中位随访时间5.8年后，16494名（39.4%）女性死亡；其中9953名（60.3%）死于乳腺癌。不同郡县的五年乳腺癌特异性生存率在74.1%至80.6%之间。排除受邀参加乳腺钼靶筛查的女性后的年龄调整分析显示，郡县之间乳腺癌生存率存在20%的差异（风险比0.80；95%可信区间0.72 - 0.90；p < 0.001）。对于诊断为二期肿瘤的女性，差异为45%。郡县之间的治疗存在差异，但在研究期间不同郡县的治疗趋势相似。
挪威郡县之间乳腺癌生存率存在显著差异。可能的解释是乳腺钼靶筛查、诊断和治疗的提供存在差异。
