Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia.
Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Clin J Am Soc Nephrol. 2017 Jan 6;12(1):95-104. doi: 10.2215/CJN.05990616. Epub 2016 Dec 29.
Breast and cervical cancers are prevalent in women with CKD, but it is uncertain how often screening for these cancers should be undertaken given concerns that the benefits of screening may be fewer and the harms greater in women with CKD than in the general population. We examined patterns of breast and cervical cancer screening in women on the basis of CKD stage and age and assessed predictors of screening.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted two population-based cohort studies (breast and cervical cancer screening) from 2002 to 2013 using linked administrative health care data from Ontario, Canada. A total of 141,326 and 324,548 women were included in the breast and cervical cancer screening cohorts, respectively.
The 2-year cumulative incidences were 61% among women without CKD, 54% for those with CKD stages 3a and 3b, 37% for those with CKD stages 4 and 5, and 26% for women on dialysis. Similar patterns were observed for the 3-year cumulative incidences of cervical cancer screening. The associations of breast and cervical cancer screening with CKD were modified by age and CKD stage, where lower incidence of screening in women with advanced CKD compared with no CKD was most pronounced in older age groups (P<0.001). Older age, higher comorbidity burden, and lower-income groups were associated with a lower rate of screening.
Most women with advanced CKD do not receive breast or cervical cancer screening. A better understanding of patient and health professional preferences toward cancer screening in CKD is needed along with the outcomes of such screening.
乳腺癌和宫颈癌在患有 CKD 的女性中较为普遍，但由于担心 CKD 女性的筛查获益可能少于普通人群，且危害可能更大，因此尚不确定应该多久对这些癌症进行一次筛查。我们根据 CKD 分期和年龄检查了女性的乳腺癌和宫颈癌筛查模式，并评估了筛查的预测因素。
设计、设置、参与者和测量方法：我们使用来自加拿大安大略省的链接行政医疗保健数据，于 2002 年至 2013 年进行了两项基于人群的队列研究（乳腺癌和宫颈癌筛查）。乳腺癌和宫颈癌筛查队列分别纳入了 141326 名和 324548 名女性。
无 CKD 女性的 2 年累积发生率为 61%，CKD 3a 和 3b 期女性为 54%，CKD 4 期和 5 期女性为 37%，透析女性为 26%。宫颈癌筛查的 3 年累积发生率也呈现出类似的模式。乳腺癌和宫颈癌筛查与 CKD 的相关性受到年龄和 CKD 分期的影响，在年龄较大的女性中，与无 CKD 相比，晚期 CKD 女性接受筛查的比例较低（P<0.001）。年龄较大、合并症负担较高和低收入群体与较低的筛查率相关。
大多数患有晚期 CKD 的女性并未接受乳腺癌或宫颈癌筛查。需要更好地了解 CKD 患者和卫生保健专业人员对癌症筛查的偏好以及此类筛查的结果。
