Fann Jean Ching-Yuan, Chang King-Jen, Hsu Chen-Yang, Yen Amy Ming-Fang, Yu Cheng-Ping, Chen Sam Li-Sheng, Kuo Wen-Hung, Tabár László, Chen Hsiu-Hsi
Department of Health Industry Management, College of Healthcare Management, Kainan University, Taoyuan 338, Taiwan.
Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan.
Cancers (Basel). 2019 Mar 7;11(3):325. doi: 10.3390/cancers11030325.
Elucidating whether and how long-term survival of breast cancer is mainly due to cure after early detection and effective treatment and therapy or overdiagnosis resulting from the widespread use of mammography provides a new insight into the role mammography plays in screening, surveillance, and treatment of breast cancer. Given information on detection modes, the impact of overdiagnosis due to mammography screening on long-term breast cancer survival was quantitatively assessed by applying a zero (cured or overdiagnosis)-inflated model design and analysis to a 15-year follow-up breast cancer cohort in Dalarna, Sweden. The probability for non-progressive breast cancer (the zero part) was 56.14% including the 44.34% complete cure after early detection and initial treatment and a small 11.80% overdiagnosis resulting from mammography screening program (8.94%) and high awareness (2.86%). The 15-year adjusted cumulative survival of breast cancer was dropped from 88.25% to 74.80% after correcting for the zero-inflated part of overdiagnosis. The present findings reveal that the majority of survivors among women diagnosed with breast cancer could be attributed to the cure resulting from mammography screening and accompanying effective treatment and therapy and only a small fraction of those were due to overdiagnosis.
阐明乳腺癌的长期生存主要是由于早期发现后的治愈以及有效的治疗手段，还是由于乳腺钼靶检查的广泛应用导致的过度诊断，这为乳腺钼靶检查在乳腺癌筛查、监测和治疗中所起的作用提供了新的见解。根据检测模式的信息，通过对瑞典达拉纳郡一个乳腺癌队列进行15年随访，并应用零膨胀模型设计和分析，定量评估了乳腺钼靶筛查导致的过度诊断对乳腺癌长期生存的影响。非进展性乳腺癌（零部分）的概率为56.14%，其中包括早期发现和初始治疗后44.34%的完全治愈，以及乳腺钼靶筛查计划（8.94%）和高知晓率（2.86%）导致的11.80%的小部分过度诊断。在对过度诊断的零膨胀部分进行校正后，乳腺癌的15年调整后累积生存率从88.25%降至74.80%。目前的研究结果表明，被诊断为乳腺癌的女性中，大多数幸存者可归因于乳腺钼靶筛查以及随之而来的有效治疗所带来的治愈，只有一小部分是由于过度诊断。
