Vyas Ami, Madhavan Suresh, Sambamoorthi Usha
Department of Pharmaceutical Systems & Policy, School of Pharmacy, Robert C. Byrd Health Sciences Center, West Virginia University, P.O. Box 9510, Morgantown, WV, 26506-9510, USA,
Breast Cancer Res Treat. 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3. Epub 2014 Nov 16.
Previous studies on the association between mammography screening and stage at breast cancer (BC) diagnosis have limitations because they did not analyze persistence with mammography screening and did not distinguish screening from diagnostic mammograms. The objective of this study is to determine the association between persistence with mammography screening and stage at BC diagnosis among elderly women. A retrospective observational study of 39,006 women age ≥70 diagnosed with incident BC from 2005 to 2009 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset was conducted. A validated algorithm with high sensitivity and specificity was used to distinguish between screening and diagnostic mammograms. Persistence with mammography screening was measured as having at least three screening mammograms in five years before BC diagnosis. Multinomial logistic regressions were performed to analyze the association between persistence with mammography screening and stage at diagnosis, in a multivariate framework. Overall, 46% of elderly women were persistent with mammography screening, 26% were not persistent, and 28% did not have any screening mammogram in five years before BC diagnosis. As compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC. The adjusted odds ratios were 3.28, 2.37, and 1.60 for in situ, local, and regional stages, respectively. A lower proportion of elderly women was persistent with mammography and it was highly associated with earlier stages of BC diagnosis. Interventions designed to promote persistent mammography screening among elderly women are warranted.
以往关于乳腺钼靶筛查与乳腺癌（BC）诊断分期之间关联的研究存在局限性，因为这些研究没有分析乳腺钼靶筛查的持续性，也没有区分筛查性钼靶和诊断性钼靶。本研究的目的是确定老年女性乳腺钼靶筛查的持续性与BC诊断分期之间的关联。对2005年至2009年从监测、流行病学和最终结果（SEER）-医疗保险数据集中确诊为原发性BC的39006名年龄≥70岁的女性进行了一项回顾性观察研究。使用一种经过验证的具有高灵敏度和特异性的算法来区分筛查性钼靶和诊断性钼靶。乳腺钼靶筛查的持续性定义为在BC诊断前五年内至少有三次筛查性钼靶检查。在多变量框架下进行多项逻辑回归分析，以分析乳腺钼靶筛查的持续性与诊断分期之间的关联。总体而言，46%的老年女性坚持进行乳腺钼靶筛查，26%的女性不坚持，28%的女性在BC诊断前五年内没有进行任何筛查性钼靶检查。与未坚持乳腺钼靶筛查的女性相比，坚持乳腺钼靶筛查的女性在BC早期被诊断的可能性显著更高。原位癌、局部癌和区域癌分期的调整后优势比分别为3.28、2.37和1.60。坚持进行乳腺钼靶筛查的老年女性比例较低，且这与BC诊断的早期阶段高度相关。有必要采取干预措施来促进老年女性坚持进行乳腺钼靶筛查。
