White E, Lee C Y, Kristal A R
Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
J Natl Cancer Inst. 1990 Oct 3;82(19):1546-52. doi: 10.1093/jnci/82.19.1546.
The breast cancer incidence rate (i.e., the detected number of new cases per 100,000 women) increased by 31% in western Washington State between the time periods 1974-1978 and 1986-1987. If this increase is largely due to earlier detection of cases through mammography, it is encouraging; otherwise (if it cannot be attributed to mammography alone), investigation of other factors may be needed. The observed increase, based on 18,559 documented breast cancer cases from the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) registry, was compared with the predicted increase based on mammography utilization by year from a survey of 1,212 women in western Washington and on data from published studies regarding the impact of mammography on the detection rate for new breast cancer cases. Among women aged 45-64, all of the increase was associated with local stage disease and with tumors detected at a smaller size. Further, the 15% observed increase in incidence in this age group was less than the 20% increase predicted due to the utilization of mammography. However, the observed increase was approximately twice the predicted increase for women aged 65-74 (observed 57%, predicted 26%) and for women aged 25-44 (observed 29%, predicted 12%). Thus, all of the increase in detected breast cancer among 45-64 year old women appears to be explained by the increased use of mammography, while among older women and younger women there may be other contributing factors. The limitations and implications of this analysis are discussed.
在1974 - 1978年至1986 - 1987年期间，华盛顿州西部的乳腺癌发病率（即每10万名女性中检测到的新病例数）上升了31%。如果这种上升主要是由于通过乳房X线摄影更早地检测出病例，那将是令人鼓舞的；否则（如果不能仅归因于乳房X线摄影），可能需要调查其他因素。基于西雅图 - 普吉特海湾监测、流行病学和最终结果（SEER）登记处记录的18559例乳腺癌病例所观察到的发病率上升，与根据对华盛顿州西部1212名女性的调查得出的每年乳房X线摄影使用率以及关于乳房X线摄影对新乳腺癌病例检测率影响的已发表研究数据所预测的发病率上升进行了比较。在45 - 64岁的女性中，所有的发病率上升都与局部阶段疾病以及检测到的较小尺寸肿瘤有关。此外，在这个年龄组中观察到的15%的发病率上升低于因使用乳房X线摄影而预测的20%的上升。然而，对于65 - 74岁的女性（观察到上升57%，预测上升26%）和25 - 44岁的女性（观察到上升29%，预测上升12%），观察到的上升大约是预测上升的两倍。因此，45 - 64岁女性中检测到的乳腺癌发病率的所有上升似乎都可以由乳房X线摄影使用的增加来解释，而在老年女性和年轻女性中可能存在其他促成因素。本文讨论了该分析的局限性和影响。
