Department of Epidemiology and Biostatistics.
University of California, San Francisco, San Francisco.
J Natl Cancer Inst. 2020 Jun 1;112(6):599-606. doi: 10.1093/jnci/djz172.
Potential benefits of screening mammography among women ages 75 years and older remain unclear.
We evaluated 10-year cumulative incidence of breast cancer and death from breast cancer and other causes by Charlson Comorbidity Index (CCI) and age in the Medicare-linked Breast Cancer Surveillance Consortium (1999-2010) cohort of 222 088 women with no less than 1 screening mammogram between ages 66 and 94 years.
During median follow-up of 107 months, 7583 were diagnosed with invasive breast cancer and 1742 with ductal carcinoma in situ; 471 died from breast cancer and 42 229 from other causes. The 10-year cumulative incidence of invasive breast cancer did not change with increasing CCI but decreased slightly with age: ages 66-74 years (CCI0 = 4.0% [95% CI = 3.9% to 4.2%] vs CCI ≥ 2 = 3.9% [95% CI = 3.5% to 4.3%]); ages 75-84 years (CCI0 = 3.7% [95% CI = 3.5% to 3.9%] vs CCI ≥ 2 = 3.4% [95% CI = 2.9% to 3.9%]); and ages 85-94 years (CCI0 = 2.7% [95% CI = 2.3% to 3.1%] vs CCI ≥ 2 = 2.1% [95% CI = 1.3% to 3.0%]). The 10-year cumulative incidence of other-cause death increased with increasing CCI and age: ages 66-74 years (CCI0 = 10.4% [95% CI = 10.3 to 10.7%] vs CCI ≥ 2 = 43.4% [95% CI = 42.2% to 44.4%]), ages 75-84 years (CCI0 = 29.8% [95% CI = 29.3% to 30.2%] vs CCI ≥ 2 = 61.7% [95% CI = 60.2% to 63.3%]), and ages 85 to 94 years (CCI0 = 60.3% [95% CI = 59.1% to 61.5%] vs CCI ≥ 2 = 84.8% [95% CI = 82.5% to 86.9%]). The 10-year cumulative incidence of breast cancer death was small and did not vary by age: ages 66-74 years = 0.2% (95% CI = 0.2% to 0.3%), ages 75-84 years = 0.29% (95% CI = 0.25% to 0.34%), and ages 85 to 94 years = 0.3% (95% CI = 0.2% to 0.4%).
Cumulative incidence of other-cause death was many times higher than breast cancer incidence and death, depending on comorbidity and age. Hence, older women with increased comorbidity may experience diminished benefit from continued screening.
75 岁及以上女性进行乳房 X 线筛查的潜在益处仍不清楚。
我们评估了 Medicare 相关乳腺癌监测联盟（1999-2010 年）队列中 222088 名年龄在 66 至 94 岁之间至少接受过一次筛查乳房 X 线检查的女性，使用 Charlson 合并症指数（CCI）和年龄来评估 10 年累积乳腺癌发病和因乳腺癌和其他原因死亡的情况。
在中位随访 107 个月期间，7583 人被诊断患有浸润性乳腺癌，1742 人患有导管原位癌；471 人死于乳腺癌，42229 人死于其他原因。浸润性乳腺癌的 10 年累积发病率与 CCI 增加无关，但随年龄略有下降：66-74 岁年龄组（CCI0=4.0% [95%CI=3.9%至 4.2%] 比 CCI≥2=3.9% [95%CI=3.5%至 4.3%]）；75-84 岁年龄组（CCI0=3.7% [95%CI=3.5%至 3.9%] 比 CCI≥2=3.4% [95%CI=2.9%至 3.9%]）；85-94 岁年龄组（CCI0=2.7% [95%CI=2.3%至 3.1%] 比 CCI≥2=2.1% [95%CI=1.3%至 3.0%]）。其他原因导致的死亡的 10 年累积发病率随 CCI 和年龄的增加而增加：66-74 岁年龄组（CCI0=10.4% [95%CI=10.3 至 10.7%] 比 CCI≥2=43.4% [95%CI=42.2%至 44.4%]）；75-84 岁年龄组（CCI0=29.8% [95%CI=29.3%至 30.2%] 比 CCI≥2=61.7% [95%CI=60.2%至 63.3%]）；85 岁至 94 岁年龄组（CCI0=60.3% [95%CI=59.1%至 61.5%] 比 CCI≥2=84.8% [95%CI=82.5%至 86.9%]）。乳腺癌死亡的 10 年累积发病率较小，与年龄无关：66-74 岁年龄组=0.2%（95%CI=0.2%至 0.3%）；75-84 岁年龄组=0.29%（95%CI=0.25%至 0.34%）；85 岁至 94 岁年龄组=0.3%（95%CI=0.2%至 0.4%）。
因其他原因导致的死亡的累积发病率远高于乳腺癌的发病和死亡，这取决于合并症和年龄。因此，合并症增加的老年女性可能会因持续筛查而获益减少。
