1 Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland.
2 Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
J Womens Health (Larchmt). 2018 Sep;27(9):1142-1151. doi: 10.1089/jwh.2017.6689. Epub 2018 Apr 30.
Excessive breast cancer screening with mammography or other modalities often burdens patients with false-positive results and costs. Yet, screening patients beyond the age at which they will benefit or at too frequent intervals persists. This review summarizes the factors associated with overuse of breast cancer screening.
We searched Medline and Embase from January 1998 to March 2017 for articles addressing the overuse of breast cancer screening and hand-searched the reference lists of included articles. Studies were included if they were written in English, pertained to a U.S. population, and identified a factor associated specifically with overuse of breast imaging. Paired reviewers independently screened abstracts, extracted data, and assessed quality.
We included 15 studies: 3 cohort, 5 cross-sectional, 6 surveys, and 1 in-depth interview. White women (non-Hispanic) were less vulnerable than other racial groups to overuse in 3 of 5 studies. Physician specialty was consistently associated with screening overuse in three of three studies. Abundant access to primary care and a patient desire for screening were associated with breast cancer screening overuse. Lower self-confidence, lower risk taking tendencies, higher perception of conflict in expert recommendations, and a belief in screening effectiveness were clinician traits associated with overuse of screening in the surveys.
The literature supports that liberal access to care and clinicians' recommendations to screen, possibly influenced by conflicting guidelines, increase excessive breast cancer screening. Overuse might conceivably be reduced with more concordance across guidelines, physician education, patient involvement in decision-making, thoughtful insurance restrictions, and limitations on the supply of services; however, these will need careful testing regarding their impact.
过度的乳腺癌筛查（如乳房 X 光检查或其他方式）往往会给患者带来假阳性结果和经济负担。然而，仍有患者在获益年龄之外或过于频繁地接受筛查。本综述总结了与乳腺癌筛查过度使用相关的因素。
我们检索了 Medline 和 Embase 数据库，检索时间为 1998 年 1 月至 2017 年 3 月，以获取有关乳腺癌筛查过度使用的文章，并对纳入文章的参考文献进行手工检索。纳入的研究需满足以下标准：用英文撰写，与美国人群相关，且明确指出与乳房成像过度使用相关的因素。两名评审员独立筛选摘要、提取数据并评估质量。
我们共纳入了 15 项研究：3 项队列研究、5 项横断面研究、6 项调查研究和 1 项深入访谈研究。在 5 项研究中的 3 项中，白人（非西班牙裔）女性比其他种族群体更少面临过度使用的风险。在 3 项研究中的 3 项中，医生的专业领域与筛查过度使用始终相关。充足的初级保健机会和患者对筛查的需求与乳腺癌筛查过度使用相关。在调查研究中，较低的自信水平、较低的风险倾向、对专家建议存在更多冲突的感知以及对筛查有效性的信念与筛查过度使用的医生特征相关。
文献支持宽松的医疗服务可及性和医生推荐筛查可能会增加过度的乳腺癌筛查。通过更一致的指南、医生教育、患者参与决策、审慎的保险限制以及服务供应的限制，可能会减少过度使用；然而，需要对其影响进行仔细的测试。
