Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Breast Cancer Res Treat. 2012 Oct;135(3):831-7. doi: 10.1007/s10549-012-2215-1. Epub 2012 Aug 30.
The beneficial impact of screening mammography on breast cancer outcome continues to be debated as demonstrated by guidelines published by the United States Preventive Services Task Force. A previous report from Rhode Island, which has a very high rate of mammographic screening, demonstrated significant improvements in invasive breast cancer presentation and mortality through 2001. This report updates data through 2008 to determine whether previous favorable trends continued. Rhode Island Cancer Registry data regarding invasive breast cancer presentation and mortality in 17,522 female residents diagnosed between 1987 and 2008, inclusive, were analyzed for demographic and pathological factors. Data were analyzed by four time periods: 1987-1992, 1993-1998, 1999-2003, and 2004-2008 and overall. Statistically significant improvements occurred over the four successive time periods, in mean cancer size (23.7, 20.9, 19.6, and 19.3 mm, p < 0.0001), pathologic grade (Grade I: 12, 15, 19, and 17 %; Grade III 57, 41, 36, and 35 %, p < 0.0001), breast conserving surgery (38, 56, 67, and 71 %, p < 0.0001) and mortality (37.3, 31.4, 25.1, and 22.6 per 100,000/year, p < 0.0001). The results showed that high screening rates favorably impacted presentation of and mortality from invasive breast cancer in Rhode Island. From 1987 to 2008, there has been a 39 % decline in breast cancer mortality considering 5 year periods (37.3 vs. 22.6 deaths per 100,000) and 41 % comparing the period from 1990 to 2008, which may exceed the goal of 50 % mortality reduction by 2015 established by the American Cancer Society.
美国预防服务工作组发布的指南表明，乳腺 X 线筛查对乳腺癌结果的有益影响仍存在争议。 此前，罗得岛州的一份报告显示，由于乳腺 X 线筛查率非常高，截至 2001 年，浸润性乳腺癌的表现和死亡率都有显著改善。本报告通过更新至 2008 年的数据，以确定以前的有利趋势是否继续。 分析了 1987 年至 2008 年期间确诊的 17522 名女性居民的罗得岛癌症登记处关于浸润性乳腺癌表现和死亡率的数据，包括人口统计学和病理学因素。 数据按四个时间段进行分析：1987-1992 年、1993-1998 年、1999-2003 年和 2004-2008 年，以及总体情况。 在四个连续的时间段中，癌症平均大小（23.7、20.9、19.6 和 19.3 毫米，p<0.0001）、病理分级（I 级：12、15、19 和 17%；III 级：57、41、36 和 35%，p<0.0001）、保乳手术（38、56、67 和 71%，p<0.0001）和死亡率（37.3、31.4、25.1 和 22.6/100,000 人/年，p<0.0001）均有显著改善。结果表明，高筛查率对罗得岛州浸润性乳腺癌的表现和死亡率产生了有利影响。 1987 年至 2008 年，考虑到 5 年期间（37.3 与 22.6 例/100,000 人），乳腺癌死亡率下降了 39%，与 1990 年至 2008 年相比下降了 41%，这可能超过了美国癌症协会设定的到 2015 年降低 50%死亡率的目标。
