Chu K C, Connor R J
Early Detection Branch, National Cancer Institute, Bethesda, MD 20892.
Am J Epidemiol. 1991 May 15;133(10):1039-49. doi: 10.1093/oxfordjournals.aje.a115813.
Reductions in breast cancer mortality in the Health Insurance Plan of Greater New York trial are examined by age at entry and stage at diagnosis using a stage shift cancer screening model. The results indicate that for women aged 40-49 years at entry, benefits are associated with an internal stage shift of stage 1 cancers that have a prognosis poorer than the usual stage 1 cancers. Further, the results indicate that after 18 years of follow-up, of the reduction of 16 fewer deaths in the intervention group, 12-15 of the deaths are related to this internal shift. Given that stage 1 cases inherently have relatively good survival, the time required to see the screening benefit is substantial. For women aged 50-64 years at entry, the results suggest that benefits are associated primarily with shifts to or within stage 1. Further, the results indicate that after 6 years, of the reduction of 31 fewer deaths in the intervention group, 22 of the deaths are related to external shifts to stage 1. Given that stage 2 cancers have poorer survival than stage 1 cancers, screening benefit is seen sooner for the older cohort than for the younger cohort.
利用阶段转移癌症筛查模型，通过入组时年龄和诊断时分期来研究纽约大健康保险计划试验中乳腺癌死亡率的降低情况。结果表明，对于入组时年龄在40 - 49岁的女性，获益与1期癌症的内部阶段转移有关，这些癌症的预后比通常的1期癌症更差。此外，结果表明，经过18年的随访，在干预组减少的16例死亡病例中，有12 - 15例死亡与这种内部转移有关。鉴于1期病例本身具有相对较好的生存率，看到筛查获益所需的时间相当长。对于入组时年龄在50 - 64岁的女性，结果表明获益主要与转移至1期或在1期内的阶段转移有关。此外，结果表明，6年后，在干预组减少的31例死亡病例中，有22例死亡与向1期的外部转移有关。鉴于2期癌症的生存率比1期癌症差，老年队列比年轻队列更早看到筛查获益。
