Erasmus MC, Department of Public Health, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands.
Br J Cancer. 2011 Mar 29;104(7):1214-20. doi: 10.1038/bjc.2011.67. Epub 2011 Mar 1.
Exposure to ionizing radiation at mammography screening may cause breast cancer. Because the radiation risk increases with lower exposure age, advancing the lower age limit may affect the balance between screening benefits and risks. The present study explores the benefit-risk ratio of screening before age 50.
The benefits of biennial mammography screening, starting at various ages between 40 and 50, and continuing up to age 74 were examined using micro-simulation. In contrast with previous studies that commonly used excess relative risk models, we assessed the radiation risks using the latest BEIR-VII excess absolute rate exposure-risk model.
The estimated radiation risk is lower than previously assessed. At a mean glandular dose of 1.3 mGy per view that was recently measured in the Netherlands, biennial mammography screening between age 50 and 74 was predicted to induce 1.6 breast cancer deaths per 100,000 women aged 0-100 (range 1.3-6.3 extra deaths at a glandular dose of 1-5 mGy per view), against 1121 avoided deaths in this population. Advancing the lower age limit for screening to include women aged 40-74 was predicted to induce 3.7 breast cancer deaths per 100,000 women aged 0-100 (range 2.9-14.4) at biennial screening, but would also prevent 1302 deaths.
The benefits of mammography screening between age 40 and 74 were predicted to outweigh the radiation risks.
在乳房 X 光筛查中接触电离辐射可能会导致乳腺癌。由于辐射风险随暴露年龄的降低而增加，因此降低下限年龄可能会影响筛查收益和风险之间的平衡。本研究探讨了 50 岁之前进行筛查的获益-风险比。
使用微观模拟方法研究了从 40 岁到 50 岁之间的各种年龄开始，每两年进行一次乳房 X 光筛查，并持续到 74 岁的获益。与以前常用超额相对风险模型的研究不同，我们使用最新的 BEIR-VII 超额绝对风险暴露风险模型评估了辐射风险。
估计的辐射风险低于以前的评估。在最近在荷兰测量的平均腺体剂量为 1.3 mGy/次的情况下，预测每两年进行一次乳房 X 光筛查，从 50 岁到 74 岁，每 100,000 名 0-100 岁的女性中会导致 1.6 例乳腺癌死亡（在腺体剂量为 1-5 mGy/次时，范围为 1.3-6.3 例额外死亡），而在该人群中会预防 1121 例死亡。将筛查的下限年龄提前到包括 40-74 岁的女性，预测每两年进行一次乳房 X 光筛查，会导致每 100,000 名 0-100 岁的女性中会发生 3.7 例乳腺癌死亡（范围为 2.9-14.4），但也会预防 1302 例死亡。
预测 40-74 岁之间的乳房 X 光筛查的收益将超过辐射风险。
