Lee Cindy S, Ashih Heidi, Sengupta Debapriya, Sickles Edward A, Zuley Margarita, Pisano Etta
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; Department of Radiology, New York University Langone Health, Garden City, New York.
Center for Research and Innovation, ACR, Reston, Virginia.
J Am Coll Radiol. 2020 Mar;17(3):368-376. doi: 10.1016/j.jacr.2019.08.033. Epub 2019 Sep 18.
There is insufficient large-scale evidence for screening mammography in women <40 years at elevated risk. This study compares risk-based screening of women aged 30 to 39 with risk factors versus women aged 40 to 49 without risk factors in the National Mammography Database (NMD).
This retrospective, HIPAA-compliant, institutional review board-exempt study analyzed data from 150 NMD mammography facilities in 31 states. Patients were stratified by 5-year age intervals, availability of prior mammograms, and specific risk factors for breast cancer: family history of breast cancer, personal history of breast cancer, and dense breasts. Four screening performance metrics were calculated for each age and risk group: recall rate (RR), cancer detection rate (CDR), and positive predictive values for biopsy recommended (PPV) and biopsy performed (PPV).
Data from 5,986,131 screening mammograms performed between January 2008 and December 2015 in 2,647,315 women were evaluated. Overall, mean CDR was 3.69 of 1,000 (95% confidence interval: 3.64-3.74), RR was 9.89% (9.87%-9.92%), PPV was 20.1% (19.9%-20.4%), and PPV was 28.2% (27.0%-28.5%). Women aged 30 to 34 and 35 to 39 had similar CDR, RR, and PPVs, with the presence of the three evaluated risk factors associated with significantly higher CDR. Moreover, compared with a population currently recommended for screening mammography in the United States (aged 40-49 at average risk), incidence screening (at least one prior screening examination) of women aged 30 to 39 with the three evaluated risk factors has similar cancer detection rates and recall rates.
Women with one or more of these three specific risk factors likely benefit from screening commencing at age 30 instead of age 40.
对于风险升高的40岁以下女性进行乳腺钼靶筛查，目前尚无充分的大规模证据。本研究在国家乳腺钼靶数据库（NMD）中，比较了有风险因素的30至39岁女性与无风险因素的40至49岁女性基于风险的筛查情况。
这项回顾性、符合健康保险流通与责任法案（HIPAA）且无需机构审查委员会批准的研究，分析了来自31个州150个NMD乳腺钼靶检查机构的数据。患者按5岁年龄间隔、既往乳腺钼靶检查情况以及乳腺癌的特定风险因素进行分层：乳腺癌家族史、个人乳腺癌病史和乳腺致密。为每个年龄和风险组计算了四个筛查性能指标：召回率（RR）、癌症检出率（CDR）以及活检推荐阳性预测值（PPV）和活检实施阳性预测值（PPV）。
对2008年1月至2015年12月期间在2,647,315名女性中进行的5,986,131次乳腺钼靶筛查数据进行了评估。总体而言，平均癌症检出率为每1000人中有3.69例（95%置信区间：3.64 - 3.74），召回率为9.89%（9.87% - 9.92%），活检推荐阳性预测值为20.1%（19.9% - 20.4%），活检实施阳性预测值为28.2%（27.0% - 28.5%）。30至34岁和35至39岁的女性具有相似的癌症检出率、召回率和阳性预测值，存在这三个评估的风险因素与显著更高的癌症检出率相关。此外，与目前美国推荐进行乳腺钼靶筛查的人群（平均风险的40 - 49岁）相比，有这三个评估风险因素的30至39岁女性进行发病率筛查（至少有一次既往筛查检查）具有相似的癌症检出率和召回率。
有这三个特定风险因素中一个或多个的女性可能从30岁而非40岁开始筛查中获益。
