Group Health Research Institute, Seattle, Washington.
Cancer. 2013 Nov 15;119(22):3959-67. doi: 10.1002/cncr.28310. Epub 2013 Aug 26.
Biennial screening mammography retains most of the benefits of annual breast cancer screening with reduced harms. Whether screening guidelines based on race/ethnicity and age would be more effective than age-based guidelines is unknown.
Mammography data from the Breast Cancer Surveillance Consortium were linked to pathology and tumor databases. The authors identified women aged 40 to 74 years who underwent annual, biennial, or triennial screening mammography between 1994 and 2008. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (95% CI) of adverse tumor characteristics among 14,396 incident breast cancer cases and 10-year cumulative risks of false-positive recall and biopsy recommendation among 1,276,312 noncases.
No increased risk of adverse tumor characteristics associated with biennial versus annual screening were noted in white women, black women, Hispanic women aged 40 to 49 years, or Asian women aged 50 to 74 years. Hispanic women aged 50 to 74 years who screened biennially versus annually were found to have an increased risk of late-stage disease (OR, 1.6; 95% CI, 1.0-2.5) and large tumors (OR, 1.6; 95% CI, 1.1-2.4). Asian women aged 40 to 49 years who underwent biennial screening had an elevated risk of positive lymph nodes (OR, 3.1; 95% CI, 1.3-7.1). No elevated risks were associated with triennial versus biennial screening. Cumulative false-positive risks decreased markedly with a longer screening interval.
The authors found limited evidence of elevated risks of adverse tumor characteristics with biennial versus annual screening, whereas cumulative false-positive risks were lower. However, elevated risks of late-stage disease in Hispanic women and lymph node-positive disease in younger Asian women who screened less often than annually warrant consideration and replication.
与年度乳腺癌筛查相比，每两年进行一次筛查保留了大部分益处，同时降低了危害。目前尚不清楚基于种族/民族和年龄的筛查指南是否比基于年龄的指南更有效。
作者将乳腺癌监测联盟的乳房 X 光检查数据与病理学和肿瘤数据库进行了关联。他们确定了 1994 年至 2008 年期间接受年度、每两年一次或每三年一次筛查乳房 X 光检查的 40 岁至 74 岁女性。使用逻辑回归估计了 14396 例新发乳腺癌病例中不良肿瘤特征的调整比值比（OR）和 95%置信区间（95%CI），以及 1276312 例非病例中 10 年累积假阳性召回和活检建议的风险。
在白人、黑人、40 至 49 岁的西班牙裔和 50 至 74 岁的亚裔女性中，与年度筛查相比，每两年进行一次筛查并没有增加不良肿瘤特征的风险。与每年筛查相比，50 至 74 岁的西班牙裔女性每两年筛查一次，其晚期疾病的风险增加（OR，1.6；95%CI，1.0-2.5）和肿瘤较大（OR，1.6；95%CI，1.1-2.4）。40 至 49 岁的亚洲女性每两年进行一次筛查，其淋巴结阳性的风险增加（OR，3.1；95%CI，1.3-7.1）。与每两年筛查相比，每三年筛查一次没有增加风险。随着筛查间隔的延长，累积假阳性风险显著降低。
作者发现，与年度筛查相比，每两年筛查一次与不良肿瘤特征风险升高之间的关联证据有限，而累积假阳性风险较低。然而，每两年筛查一次的西班牙裔女性晚期疾病风险升高和亚洲年轻女性淋巴结阳性疾病风险升高值得考虑和重复研究。
