2009 - 2012年国家乳腺癌和宫颈癌早期检测项目中乳房X光检查的临床结果
Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009-2012.
作者信息
White Arica, Miller Jacqueline, Royalty Janet, Ryerson A Blythe, Benard Vicki, Helsel William, Kammerer William
机构信息
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Mailstop F76, Atlanta, GA, 30341-3717, USA,
出版信息
Cancer Causes Control. 2015 May;26(5):723-32. doi: 10.1007/s10552-015-0567-7. Epub 2015 Mar 26.
PURPOSE
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. This study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group.
METHODS
For the first NBCCEDP-funded mammogram received during 2009-2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication.
RESULTS
The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50-64 compared to those aged 40-49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1).
CONCLUSIONS
Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50-64 years compared to women aged 40-49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50-64 years and providing both screening and diagnostic mammograms.
目的
国家乳腺癌和宫颈癌早期检测项目（NBCCEDP）为无症状女性进行癌症筛查，为有症状女性提供诊断服务。本研究描述了NBCCEDP提供的乳房X光检查结果，按检查指征（筛查或诊断）和年龄组划分。
方法
对于2009年至2012年期间首次接受NBCCEDP资助的乳房X光检查，我们计算了特定年龄的异常发现百分比、后续检测率以及每1000例乳房X光检查的浸润性和原位乳腺癌诊断率。使用逻辑回归按检查指征估计这些结果中每一项的比值比。
结果
NBCCEDP为1,147,393名女性提供了941,649例筛查乳房X光检查、175,310例诊断乳房X光检查和30,434例指征不明的乳房X光检查。诊断性乳房X光检查的异常乳房X光检查百分比（40.1%）高于筛查性乳房X光检查（15.5%）。与40至49岁的女性相比，50至64岁的女性筛查（13.7%对19.7%）和诊断性乳房X光检查（37.7%对42.7%）的异常结果较少。每1000例乳房X光检查的后续检测率在50至64岁的女性中低于40至49岁的女性（筛查：143.9对207.5；诊断：645.3对760.9）；活检率呈现类似模式（筛查：24.1对32.9；诊断：167.7对169.7）。对于筛查性乳房X光检查，老年女性比年轻女性检测到更多癌症（浸润性：3.6对2.2；原位：2.3对2.0）。同样，对于诊断性乳房X光检查，老年女性的癌症检测率更高（浸润性：67.8对36.6；原位：17.4对11.1）。
结论
与40至49岁的女性相比，50至64岁的女性异常乳房X光检查和诊断性后续程序较少，而乳腺癌检测率更高，无论乳房X光检查的指征如何。这些年龄组之间的一些差异在筛查性乳房X光检查中比在诊断性乳房X光检查中更大。诊断性乳房X光检查的癌症检测率高于筛查性乳房X光检查。这些发现支持了NBCCEDP为50至64岁女性服务并提供筛查和诊断性乳房X光检查的优先事项。
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