Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK.
J R Soc Med. 2013 Jun;106(6):234-42. doi: 10.1177/0141076813486779.
To investigate whether mortality statistics show an effect of mammographic screening on population-based breast cancer mortality in England.
Joinpoint regression analyses, and other analyses, of population-based mortality data.
Analysis of mortality rates in the Oxford region, UK (1979-2009) because, unlike the rest of England, all causes of death mentioned on each death certificate for its residents (not just the underlying cause) are available prior to commencement of the English National Breast Screening Programme (NHSBSP). In addition, analysis of English national breast cancer mortality rates (1971-2009).
Women who died from breast cancer in the Oxford region (1979--2009) and England (1971--2009) MAIN OUTCOME MEASURES: Age-specific mortality rates, and age-standardized mortality rates. Joinpoint regression analysis was used to estimate years ('joinpoints') in which trends changed, and annual percentage change between joinpoints, with confidence intervals.
In the Oxford region, trends for breast cancer mortality based on underlying cause and on mentions were very similar. For all ages combined, mortality rates peaked for both underlying cause and mentions in 1985 and then started to decline, prior to the introduction of the NHSBSP in 1988. Between 1979 and 2009, for mortality measured as underlying cause, rates declined by -2.1% (95% CI -2.7 to -1.4) per year for women aged 40-49 years (unscreened), and by the same percentage per year (-2.1% [-2.4 to -1.7]) for women aged 50-64 years (screened). In England, the first estimated changes in trend occurred prior to the introduction of screening, or before screening was likely to have had an effect (between 1982 and 1989). Thereafter, the downward trend was greatest in women aged under 40 years: -2.0% per year (-2.8 to -1.2) in 1988-2001 and -5.0% per year (-6.7 to -3.3) in 2001-2009. There was no evidence that declines in mortality rates were consistently greater in women in age groups and cohorts that had been screened at all, or screened several times, than in other (unscreened) women, in the same time periods. Conclusions Mortality statistics do not show an effect of mammographic screening on population-based breast cancer mortality in England.
探讨死亡率统计数据是否显示英国乳腺筛查对人群乳腺癌死亡率的影响。
基于人群死亡率数据的 Joinpoint 回归分析和其他分析。
英国牛津地区（1979-2009 年）的死亡率分析，因为与英格兰其他地区不同，其居民每一份死亡证明上提到的所有死因（不仅仅是根本死因）在英国国家乳腺筛查计划（NHSBSP）开始之前都可以获得。此外，还分析了英国全国乳腺癌死亡率（1971-2009 年）。
在牛津地区（1979-2009 年）和英格兰（1971-2009 年）死于乳腺癌的女性。
特定年龄死亡率和年龄标准化死亡率。采用 Joinpoint 回归分析估计趋势变化的年份（“joinpoints”）以及 joinpoints 之间的年百分比变化，置信区间。
在牛津地区，基于根本原因和提及的乳腺癌死亡率趋势非常相似。对于所有年龄组，根本死因和提及的死亡率均在 1985 年达到峰值，然后在 1988 年 NHSBSP 引入之前开始下降。在 1979 年至 2009 年期间，对于作为根本死因测量的死亡率，40-49 岁（未筛查）女性每年下降 2.1%（95%CI-2.7%至-1.4%），50-64 岁（筛查）女性每年下降相同百分比（2.1%[-2.4%至-1.7%]）。在英格兰，首次估计的趋势变化发生在引入筛查之前，或者在筛查可能产生影响之前（1982 年至 1989 年之间）。此后，40 岁以下女性的下降趋势最大：1988-2001 年每年下降 2.0%（-2.8%至-1.2%），2001-2009 年每年下降 5.0%（-6.7%至-3.3%）。没有证据表明，在同一时期，在所有或多次接受筛查的年龄组和队列中，死亡率的下降始终大于其他（未筛查）女性。
死亡率统计数据并未显示英国乳腺筛查对人群乳腺癌死亡率的影响。
