Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ann Surg Oncol. 2018 Oct;25(10):2979-2986. doi: 10.1245/s10434-018-6646-8. Epub 2018 Jul 9.
Screening mammography reduces breast cancer mortality; however, screening recommendations, ordering, and compliance remain suboptimal and controversies regarding the value of screening persist. We evaluated the influence of screening mammography on the extent of breast cancer treatment.
Patients ≥ 40 years of age diagnosed with breast cancer from September 2008 to May 2016 at a single institution were divided into two groups: those with screening 1-24 months prior to diagnosis, and those with screening at 25+ months, including patients with no prior mammography. The association between the two groups and various clinical factors were assessed using logistic regression models. Subgroup analysis was performed based on age groups.
Analysis included 1125 patients, 819 (73%) with screening at 1-24 months, and 306 (27%) with screening at 25+ months, including 65 (6%) who never had mammography. Overall, patients in the 25+ months group were more likely to receive chemotherapy [odds ratio (OR) 1.51, p = 0.0040], undergo mastectomy (OR 1.32, p = 0.0465), and require axillary dissection (AD; OR 1.66, p = 0.0045) than those in 1-24 months group. On subgroup analysis, patients aged 40-49 years with no prior mammography were more likely to have larger tumors (p = 0.0323) and positive nodes (OR 4.52, p = 0.0058), undergo mastectomy (OR 3.44, p = 0.0068), undergo AD (OR 4.64, p = 0.0002), and require chemotherapy (OR 2.52, p = 0.0287) than the 1-24 months group.
Screening mammography is associated with decreased stage at diagnosis and receipt of less-extensive treatment. This was evident in all groups, including the 40-49 years age group, where controversy exists on whether screening is even necessary.
筛查性乳房 X 光检查可降低乳腺癌死亡率；然而，筛查建议、筛查的实施和患者的遵从性仍然不理想，且有关筛查价值的争议仍在持续。我们评估了筛查性乳房 X 光检查对乳腺癌治疗范围的影响。
将 2008 年 9 月至 2016 年 5 月在一家医疗机构就诊的年龄≥40 岁的乳腺癌患者分为两组：诊断前 1-24 个月进行筛查的患者，以及诊断前 25 个月以上进行筛查的患者，包括无既往乳房 X 光检查史的患者。使用逻辑回归模型评估两组与各种临床因素之间的关系。基于年龄组进行亚组分析。
分析共纳入 1125 例患者，其中 819 例（73%）在 1-24 个月内进行了筛查，306 例（27%）在 25 个月以上进行了筛查，包括 65 例（6%）从未进行过乳房 X 光检查。总体而言，25 个月以上组的患者更有可能接受化疗[优势比（OR）1.51，p=0.0040]、接受乳房切除术（OR 1.32，p=0.0465）和需要腋窝清扫术（AD；OR 1.66，p=0.0045），而 1-24 个月组的患者则较少接受这些治疗。在亚组分析中，无既往乳房 X 光检查史且年龄为 40-49 岁的患者更有可能存在较大的肿瘤（p=0.0323）和阳性淋巴结（OR 4.52，p=0.0058），更有可能接受乳房切除术（OR 3.44，p=0.0068）、AD（OR 4.64，p=0.0002）和化疗（OR 2.52，p=0.0287），而不是 1-24 个月组的患者。
筛查性乳房 X 光检查与诊断时分期较低以及接受的治疗范围较小有关。这在所有组中均有体现，包括 40-49 岁年龄组，该组对于是否需要进行筛查存在争议。
