HealthStat Consulting, 12025 Ninth Ave NW, Seattle, WA 98177, USA.
Radiology. 2012 Mar;262(3):797-806. doi: 10.1148/radiol.11111734.
To analyze trends in detection method related to breast cancer stage at diagnosis, treatments, and outcomes over time among 40-49-year-old women.
i This study was institutional review board approved, with a waiver of informed consent, and HIPAA compliant. A longitudinal prospective cohort study was conducted of women aged 40-49 years who had primary breast cancer, during 1990-2008, and were identified and tracked by a dedicated registry database (n = 1977). Method of detection--patient detected (PtD), physician detected (PhysD), or mammography detected (MamD)--was chart abstracted. Disease-specific survival and relapse-free survival statistics were calculated by using the Kaplan-Meier method for stage I-IV breast cancer.
A significant increase in the percentage of MamD breast cancer over time (28%-58%) and a concurrent decline in patient and physician detected (Pt/PhysD) breast cancer (73%-42%) (Pearson x(2) = 72.72, P < .001) were observed over time from 1990 to 2008, with an overall increase in lower-stage disease detection and a decrease in higher-stage disease. MamD breast cancer patients were more likely to undergo lumpectomy (67% vs 48% of Pt/PhysD breast cancer patients) and less likely to undergo modified radical mastectomy (25% vs 47% of the Pt/PhysD breast cancer patients) (P < .001). Uncorrected for stage, 13% of MamD breast cancer patients underwent surgery and chemotherapy versus 22% of Pt/PhysD breast cancer patients (P < .001), and 31% of MamD breast cancer patients underwent surgery, radiation therapy, and chemotherapy versus 59% of Pt/PhysD breast cancer patients (x(2) = 305.13, P < .001). Analyzing invasive cancers only, 5-year relapse-free survival for MamD breast cancer patients was 92% versus 88% for Pt/PhysD patients (log-rank test, 12.47; P < .001).
Increased mammography-detected breast cancer over time coincided with lower-stage disease detection resulting in reduced treatment and lower rates of recurrence, adding factors to consider when evaluating the benefits of mammography screening of women aged 40-49 years.
分析 40-49 岁女性乳腺癌诊断时的检测方法、治疗方法和结果的趋势随时间的变化。
本研究经机构审查委员会批准，患者签署了豁免知情同意书，符合 HIPAA 规定。对 1990-2008 年期间患有原发性乳腺癌且被专用登记数据库识别和跟踪的 40-49 岁女性进行了一项前瞻性队列研究（n=1977）。检测方法包括患者发现（PtD）、医生发现（PhysD）或乳房 X 线摄影发现（MamD），通过图表摘要进行记录。采用 Kaplan-Meier 方法计算 I-IV 期乳腺癌的疾病特异性生存和无复发生存率统计数据。
1990 年至 2008 年间，随着时间的推移，MamD 乳腺癌的百分比显著增加（28%-58%），同时患者和医生发现（Pt/PhysD）乳腺癌的百分比下降（73%-42%）（Pearson x(2) = 72.72，P<.001），总体上发现较低分期的疾病有所增加，而较高分期的疾病则有所减少。MamD 乳腺癌患者更有可能接受乳房肿块切除术（67%比 Pt/PhysD 乳腺癌患者的 48%），不太可能接受改良根治性乳房切除术（25%比 Pt/PhysD 乳腺癌患者的 47%）（P<.001）。未校正分期时，MamD 乳腺癌患者中有 13%接受了手术和化疗，而 Pt/PhysD 乳腺癌患者中有 22%接受了手术和化疗（P<.001），MamD 乳腺癌患者中有 31%接受了手术、放疗和化疗，而 Pt/PhysD 乳腺癌患者中有 59%接受了手术、放疗和化疗（x(2) = 305.13，P<.001）。仅分析浸润性癌，MamD 乳腺癌患者的 5 年无复发生存率为 92%，而 Pt/PhysD 患者为 88%（对数秩检验，12.47；P<.001）。
随时间推移，乳房 X 线摄影发现的乳腺癌病例增加，同时发现了较低分期的疾病，导致治疗减少，复发率降低，这在评估 40-49 岁女性乳房 X 线筛查的益处时需要考虑到这些因素。
