Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Ann Oncol. 2010 May;21 Suppl 3:iii97-102. doi: 10.1093/annonc/mdq095.
A downturn in breast cancer (BC) incidence among Spanish women has been recently reported and attributed to screening saturation. This article analyses BC trends and their relationship with the introduction of the screening programme in all Spanish regions having available information.
The study covers the period 1980-2004. All Spanish population-based cancer registries with 10 years of uninterrupted registration furnished data on invasive BC. Trends in BC incidence among women aged <45 years and among those aged > or =45 years were assessed using Poisson transition models to estimate the existence of a change-point in the overall trend. Furthermore, in those regions that had registered BC incidence before implementing the screening programme, the annual percentage change in women aged > or =45 years was computed before screening, during the first round of screening and after full coverage had been achieved.
The study included 82 699 incident cases. Whereas BC increased during the 1980s and 1990s, from 2001 onwards a decline was observed among women aged > or =45 years. This phenomenon was clearly visible in regions that had implemented BC screening before 2000 and attained high participation rates. In such areas, BC incidence rose sharply during screening implementation, with an overall increase of approximately 20%-30%. BC incidence fell once full coverage was achieved and tended to level off or even increase thereafter, as was the case in Navarre. In women aged <45 years, BC increased by 1.7% per annum across the period.
Screening has strongly influenced recent BC trends among Spanish women aged > or =45 years. Our results support the influence of screening saturation on the recent decline of BC. Among younger women, incidence is still rising, probably reflecting the lifestyle changes observed in younger generations.
最近有报道称，西班牙女性的乳腺癌（BC）发病率出现下降，这归因于筛查的饱和。本文分析了所有有相关信息的西班牙地区引入筛查项目前后 BC 发病趋势及其关系。
本研究覆盖了 1980-2004 年。所有具有 10 年连续登记的基于人群的癌症登记处都提供了浸润性 BC 的数据。采用泊松过渡模型评估了<45 岁和≥45 岁女性 BC 发病率的趋势，以估计总体趋势是否存在变化点。此外，在那些已经实施筛查项目的地区，计算了在实施筛查之前、第一轮筛查期间以及完全覆盖之后≥45 岁女性的发病率年变化百分比。
本研究共纳入 82699 例新发病例。尽管在 20 世纪 80 年代和 90 年代 BC 有所增加，但从 2001 年开始，≥45 岁女性的 BC 发病率出现下降。在那些在 2000 年之前实施了 BC 筛查并达到高参与率的地区，这种现象尤为明显。在这些地区，在实施筛查期间，BC 发病率急剧上升，总体增加了约 20%-30%。一旦达到完全覆盖，BC 发病率就会下降，并趋于平稳甚至上升，纳瓦拉就是如此。在<45 岁的女性中，BC 的发病率在整个研究期间每年增加 1.7%。
筛查强烈影响了西班牙≥45 岁女性最近的 BC 发病趋势。我们的结果支持筛查饱和对最近 BC 下降的影响。在年轻女性中，发病率仍在上升，这可能反映了年轻一代生活方式的变化。
