Zakaria D, Shaw A
Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, 785 Carling Ave, Ottawa, ON, K1A 0K9, Canada.
Cancer Causes Control. 2019 Feb;30(2):137-147. doi: 10.1007/s10552-019-1127-3. Epub 2019 Jan 14.
The purpose of the study is to examine relationships between long-term trends of region- and age-specific rates of mammography, hormone replacement therapy (HRT), and breast cancer incidence and mortality in Canadian women aged 35 years and older.
Population-based complex surveys were used to estimate mammography use in the past 2 years and ever, and HRT use in the past month. National population-based administrative data were used to estimate breast cancer incidence and mortality. Joinpoint analyses were used to estimate trends in rates and years where trend changed.
No consistent relationship between mammography use and breast cancer incidence was observed across age groups. Opportunistic screening occurred prior to the establishment of organized screening programs in Canada and prior to substantial declines in breast cancer mortality observed around 1990. Women aged 35-39 years demonstrated a 62.8% relative decrease in breast cancer mortality between 1950 and 2015 despite lower rates of mammography use in the past 2 years (range 9.4-15.9%) reinforcing important treatment advances. A substantial proportion of women in their 40s report mammography use in the past 2 years (range 35.8-42.2%) and regional variation exists reflecting inconsistencies in guidelines across Canada.
Rates of mammography use over time do not necessarily reflect national guideline releases or establishment of organized screening programs.
本研究旨在探讨加拿大35岁及以上女性中，按地区和年龄划分的乳房X光检查率、激素替代疗法（HRT）以及乳腺癌发病率和死亡率的长期趋势之间的关系。
采用基于人群的复杂调查来估计过去2年及既往的乳房X光检查使用率，以及过去1个月的HRT使用率。基于全国人群的行政数据用于估计乳腺癌的发病率和死亡率。采用Joinpoint分析来估计发病率和趋势发生变化的年份的趋势。
各年龄组中均未观察到乳房X光检查使用率与乳腺癌发病率之间存在一致的关系。在加拿大有组织的筛查计划建立之前以及1990年左右乳腺癌死亡率大幅下降之前，就已存在机会性筛查。尽管过去2年乳房X光检查使用率较低（范围为9.4%-15.9%），但35-39岁女性在1950年至2015年间乳腺癌死亡率相对下降了62.8%，这强化了重要的治疗进展。40多岁的女性中有很大比例报告在过去2年进行过乳房X光检查（范围为35.8%-42.2%），且存在地区差异，这反映了加拿大各地指南的不一致。
随着时间推移，乳房X光检查使用率不一定反映国家指南的发布或有组织的筛查计划的建立。
