建模人口筛查对美国乳腺癌死亡率的影响。
Modeling the impact of population screening on breast cancer mortality in the United States.
机构信息
Department of Oncology and Medicine, Georgetown University Medical Center and Cancer Control Program, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St, NW, Suite 4100, Washington, DC 20007, USA.
出版信息
Breast. 2011 Oct;20 Suppl 3(Suppl 3):S75-81. doi: 10.1016/S0960-9776(11)70299-5.
OBJECTIVE
Optimal US screening strategies remain controversial. We use six simulation models to evaluate screening outcomes under varying strategies.
METHODS
The models incorporate common data on incidence, mammography characteristics, and treatment effects. We evaluate varying initiation and cessation ages applied annually or biennially and calculate mammograms, mortality reduction (vs. no screening), false-positives, unnecessary biopsies and over-diagnosis.
RESULTS
The lifetime risk of breast cancer death starting at age 40 is 3% and is reduced by screening. Screening biennially maintains 81% (range 67% to 99%) of annual screening benefits with fewer false-positives. Biennial screening from 50-74 reduces the probability of breast cancer death from 3% to 2.3%. Screening annually from 40 to 84 only lowers mortality an additional one-half of one percent to 1.8% but requires substantially more mammograms and yields more false-positives and over-diagnosed cases.
CONCLUSION
Decisions about screening strategy depend on preferences for benefits vs. potential harms and resource considerations.
目的
最佳的 US 筛查策略仍存在争议。我们使用六个模拟模型来评估不同策略下的筛查结果。
方法
这些模型纳入了关于发病率、乳房 X 线特征和治疗效果的常见数据。我们评估了每年或每两年开始和停止的不同年龄，并计算了乳房 X 光片、死亡率降低（与不筛查相比）、假阳性、不必要的活检和过度诊断。
结果
从 40 岁开始，乳腺癌死亡的终生风险为 3%，筛查可降低风险。每两年筛查一次可保持 81%（67%至 99%）的年度筛查益处，假阳性更少。从 50 岁到 74 岁每两年筛查一次，可将乳腺癌死亡的概率从 3%降低到 2.3%。从 40 岁到 84 岁每年筛查一次，仅使死亡率再降低半分之一，至 1.8%，但需要进行更多的乳房 X 光检查，并产生更多的假阳性和过度诊断病例。
结论
筛查策略的决策取决于对益处与潜在危害和资源考虑的偏好。
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