van der Waal Daniëlle, Ripping Theodora M, Verbeek André L M, Broeders Mireille J M
Radboud university medical center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands.
Dutch Reference Centre for Screening, GJ 6503, Nijmegen, The Netherlands.
Int J Cancer. 2017 Jan 1;140(1):41-49. doi: 10.1002/ijc.30430. Epub 2016 Sep 24.
Breast cancer screening is known to reduce breast cancer mortality. A high breast density may affect this reduction. We assessed the effect of screening on breast cancer mortality in women with dense and fatty breasts separately. Analyses were performed within the Nijmegen (Dutch) screening programme (1975-2008), which invites women (aged 50-74 years) biennially. Performance measures were determined. Furthermore, a case-control study was performed for women having dense and women having fatty breasts. Breast density was assessed visually with a dichotomized Wolfe scale. Breast density data were available for cases. The prevalence of dense breasts among controls was estimated with age-specific rates from the general population. Sensitivity analyses were performed on these estimates. Screening performance was better in the fatty than in the dense group (sensitivity 75.7% vs 57.8%). The mortality reduction appeared to be smaller for women with dense breasts, with an odds ratio (OR) of 0.87 (95% CI 0.52-1.45) in the dense and 0.59 (95% CI 0.44-0.79) in the fatty group. We can conclude that high density results in lower screening performance and appears to be associated with a smaller mortality reduction. Breast density is thus a likely candidate for risk-stratified screening. More research is needed on the association between density and screening harms.
已知乳腺癌筛查可降低乳腺癌死亡率。高乳腺密度可能会影响这种降低效果。我们分别评估了筛查对乳腺致密型和脂肪型女性乳腺癌死亡率的影响。分析在奈梅亨（荷兰）筛查项目（1975 - 2008年）中进行，该项目每两年邀请50 - 74岁的女性参加。确定了性能指标。此外，对乳腺致密型女性和脂肪型女性进行了病例对照研究。采用二分法沃尔夫量表对乳腺密度进行视觉评估。病例有乳腺密度数据。根据一般人群的年龄特异性率估计对照组中致密乳腺的患病率。对这些估计值进行了敏感性分析。脂肪型组的筛查性能优于致密型组（敏感性分别为75.7%和57.8%）。致密乳腺女性的死亡率降低似乎较小，致密型组的比值比（OR）为0.87（95%可信区间0.52 - 1.45），脂肪型组为0.59（95%可信区间0.44 - 0.79）。我们可以得出结论，高乳腺密度导致筛查性能较低，且似乎与较小的死亡率降低相关。因此，乳腺密度可能是风险分层筛查的一个候选因素。关于密度与筛查危害之间的关联还需要更多研究。
