针对40多岁女性的乳腺钼靶筛查：美国癌症协会和美国预防服务工作组乳腺癌筛查建议的潜在影响。
Screening Mammography for Women in Their 40s: The Potential Impact of the American Cancer Society and U.S. Preventive Services Task Force Breast Cancer Screening Recommendations.
作者信息
Pitman Jenifer A, McGinty Geraldine B, Soman Rohan R, Drotman Michele B, Reichman Melissa B, Arleo Elizabeth Kagan
机构信息
1 Weill Cornell Medical College, 1300 York Ave, New York, NY 10065.
2 New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.
出版信息
AJR Am J Roentgenol. 2017 Sep;209(3):697-702. doi: 10.2214/AJR.16.17759. Epub 2017 May 15.
OBJECTIVE
The purpose of this study was to review screening mammograms obtained in one practice with the primary endpoint of determining the rate of detection of breast cancer and associated prognostic features in women 40-44 and 45-49 years old.
MATERIALS AND METHODS
The retrospective cohort study included women in their 40s with breast cancer detected at screening from June 2014 through May 2016. The focus was on cancer detection rate, pathologic findings, and risk factors.
RESULTS
A total of 32,762 screens were performed, and 808 biopsies were recommended. These biopsies yielded 224 breast cancers (cancer detection rate, 6.84 per 1000 screens). Women 40-49 years old had 18.8% of cancers detected; 50-59 years, 21.8%; 60-69 years, 32.6%; and 70-79 years, 21.4%. Among the 40- to 49-year-old women, women 40-44 years old underwent 5481 (16.7%) screens, had 132 biopsies recommended, and had 20 breast cancers detected (cancer detection rate, 3.6/1000). Women 45-49 years old underwent 5319 (16.2%) screens, had 108 biopsies recommended, and had 22 breast cancers detected (cancer detection rate, 4.1/1000). Thus, women 40-44 years old had 8.9% and women 45-49 years old had 9.8% of all screen-detected breast cancers. Of these only a small percentage of women with detected cancers had a first-degree relative with breast cancer (40-44 years, 15%; 45-49 years, 32%) or a BRCA mutation (40-44 years, 5%; 45-49 years, 5%), and over 60% of the cancers were invasive.
CONCLUSION
Women 40-49 years old had 18.8% of all screen-detected breast cancers. The two cohorts (40-44 and 45-49 years old) had similar incidences of screen-detected breast cancer (8.9%, 9.8%) and cancer detection rates within performance benchmark standards, supporting a similar recommendation for both cohorts and the American College of Radiology recommendation of annual screening mammography starting at age 40.
目的
本研究旨在回顾在一家医疗机构进行的乳腺钼靶筛查，主要终点是确定40 - 44岁和45 - 49岁女性乳腺癌的检出率及相关预后特征。
材料与方法
这项回顾性队列研究纳入了2014年6月至2016年5月筛查时发现患有乳腺癌的40多岁女性。重点关注癌症检出率、病理结果和风险因素。
结果
共进行了32762次筛查，推荐了808次活检。这些活检确诊了224例乳腺癌（癌症检出率为每1000次筛查6.84例）。40 - 49岁女性的癌症检出率为18.8%；50 - 59岁为21.8%；60 - 69岁为32.6%；70 - 79岁为21.4%。在40至49岁的女性中，40 - 44岁的女性接受了5481次（16.7%）筛查，推荐了132次活检，检出20例乳腺癌（癌症检出率为3.6/1000）。45 - 49岁的女性接受了5319次（16.2%）筛查，推荐了108次活检，检出22例乳腺癌（癌症检出率为4.1/1000）。因此，40 - 44岁的女性占所有筛查发现乳腺癌的8.9%，45 - 49岁的女性占9.8%。在这些检出癌症的女性中，只有一小部分有乳腺癌一级亲属（40 - 44岁，15%；45 - 49岁，32%）或携带BRCA突变（40 - 44岁，5%；45 - 49岁，5%），且超过60%的癌症为浸润性。
结论
40 - 49岁女性占所有筛查发现乳腺癌的18.8%。两个队列（40 - 44岁和45 - 49岁）筛查发现乳腺癌的发病率相似（8.9%，9.8%），且癌症检出率在性能基准标准范围内，支持对两个队列给出类似建议以及美国放射学会从40岁开始每年进行乳腺钼靶筛查的建议。
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