Seidman H, Gelb S K, Silverberg E, LaVerda N, Lubera J A
Department of Epidemiology and Statistics, American Cancer Society, New York, New York.
CA Cancer J Clin. 1987 Sep-Oct;37(5):258-90. doi: 10.3322/canjclin.37.5.258.
Very high survival rates have been observed in four through 11 years of follow-up in 4,240 women with a histologically confirmed diagnosis of breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP). The relative five, eight, and 10-year survival rates were 88, 83, and 79 percent, respectively. Allowances were made for lead-time bias among cancers detected through screening, and the validity of the findings was supported by internal analyses, which showed that length-time bias was of little, if any, importance, and that any possible "overdiagnosis" of cancer cases was also of small relevance. In view of current interest in the value of screening women before age 50, intensive analyses were made comparing the BCDDP data for women in their 40s with women in their 50s. In terms of kinds of breast cancers found, modality of finding them, and survival rates once they have been found, the parallel results for the two groups show that screening was virtually as effective in the younger as in the older women. Some authorities are of the opinion that the benefits of mammography after age 50 are well documented, but at younger ages the evidence is still inconclusive. The findings in this study show there is no doubt of the very successful results of screening for breast cancer with mammography in younger as well as older women. In comparing relative five-year and eight-year survival rates for women with invasive breast cancers detected through screening in the BCDDP, with those for cases diagnosed in the National Cancer Institute's Surveillance, Epidemiology and End Results (NCI SEER) program from 1977 to 1982, it is seen that for individual subcategories by tumor size and nodal class, the survival rates are about the same. However, for overall invasive cancers, the five-year and eight-year survival rates were 87 and 81 percent, respectively, for the BCDDP compared with 74 and 65 percent for SEER. Thus the substantial gains in survival followed the large shift toward a high proportion of cancers being diagnosed and treated in more favorable stages through the screening accomplishments. With respect to the relative case fatality rates, the complements of the relative survival rates, the eight-year rate of 19 percent for the BCDDP versus that of 35 percent for SEER connotes 46 percent fewer women dying in the BCDDP group.
在乳腺癌检测示范项目（BCDDP）中，对4240名经组织学确诊为乳腺癌的女性进行了4至11年的随访，观察到了非常高的生存率。相对的5年、8年和10年生存率分别为88%、83%和79%。对通过筛查发现的癌症中的领先时间偏倚进行了校正，内部分析支持了研究结果的有效性，该分析表明，长期偏倚即使有影响也很小，而且癌症病例的任何可能的“过度诊断”相关性也很小。鉴于目前对50岁之前女性筛查价值的关注，进行了深入分析，比较了40多岁女性和50多岁女性的BCDDP数据。就发现的乳腺癌种类、发现方式以及发现后的生存率而言，两组的平行结果表明，筛查在年轻女性中几乎与在年长女性中一样有效。一些权威人士认为，50岁以后乳腺X线摄影的益处有充分记录，但在较年轻年龄段，证据仍不确凿。本研究结果表明，毫无疑问，乳腺X线摄影筛查乳腺癌在年轻女性和年长女性中都取得了非常成功的结果。在比较BCDDP中通过筛查发现的浸润性乳腺癌女性的相对5年和8年生存率与1977年至1982年国家癌症研究所监测、流行病学和最终结果（NCI SEER）项目中诊断的病例的生存率时，可以看到，按肿瘤大小和淋巴结分类的各个亚类，生存率大致相同。然而，对于总体浸润性癌症，BCDDP的5年和8年生存率分别为87%和81%，而SEER为74%和65%。因此，通过筛查成果，大量癌症在更有利的阶段被诊断和治疗，生存率大幅提高。关于相对病死率，即相对生存率的补数，BCDDP的8年病死率为19%，而SEER为35%，这意味着BCDDP组死亡的女性少46%。
