Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts, and RTI Health Solutions, Barcelona, Spain (X.G.).
Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts (M.A.H.).
Ann Intern Med. 2020 Mar 17;172(6):381-389. doi: 10.7326/M18-1199. Epub 2020 Feb 25.
Randomized trials have shown that initiating breast cancer screening between ages 50 and 69 years and continuing it for 10 years decreases breast cancer mortality. However, no trials have studied whether or when women can safely stop screening mammography. An estimated 52% of women aged 75 years or older undergo screening mammography in the United States.
To estimate the effect of breast cancer screening on breast cancer mortality in Medicare beneficiaries aged 70 to 84 years.
Large-scale, population-based, observational study of 2 screening strategies: continuing annual mammography, and stopping screening.
U.S. Medicare program, 2000 to 2008.
1 058 013 beneficiaries aged 70 to 84 years who had a life expectancy of at least 10 years, had no previous breast cancer diagnosis, and underwent screening mammography.
Eight-year breast cancer mortality, incidence, and treatments, plus the positive predictive value of screening mammography by age group.
In women aged 70 to 74 years, the estimated difference in 8-year risk for breast cancer death between continuing and stopping screening was -1.0 (95% CI, -2.3 to 0.1) death per 1000 women (hazard ratio, 0.78 [CI, 0.63 to 0.95]) (a negative risk difference favors continuing). In those aged 75 to 84 years, the corresponding risk difference was 0.07 (CI, -0.93 to 1.3) death per 1000 women (hazard ratio, 1.00 [CI, 0.83 to 1.19]).
The available Medicare data permit only 8 years of follow-up after screening. As with any study using observational data, the estimates could be affected by residual confounding.
Continuing annual breast cancer screening past age 75 years did not result in substantial reductions in 8-year breast cancer mortality compared with stopping screening.
National Institutes of Health.
随机试验表明，在 50 至 69 岁之间开始乳腺癌筛查，并持续进行 10 年，可以降低乳腺癌死亡率。然而，尚无试验研究女性何时可以安全停止筛查性乳房 X 线检查。在美国，估计有 52%的 75 岁及以上女性接受筛查性乳房 X 线检查。
评估对 70 至 84 岁 Medicare 受种者进行乳腺癌筛查对乳腺癌死亡率的影响。
对两种筛查策略进行了大规模、基于人群的观察性研究：继续每年进行乳房 X 线摄影，以及停止筛查。
美国 Medicare 计划，2000 年至 2008 年。
1 058 013 名预期寿命至少为 10 年、无既往乳腺癌诊断且接受过筛查性乳房 X 线检查的 70 至 84 岁受种者。
8 年乳腺癌死亡率、发病率和治疗方法，以及按年龄组划分的筛查性乳房 X 线摄影的阳性预测值。
在 70 至 74 岁的女性中，继续和停止筛查之间 8 年乳腺癌死亡风险的估计差异为 -1.0（每 1000 名女性中死亡人数差异，95%CI 为-2.3 至 0.1）（风险差异负值有利于继续筛查）。在 75 至 84 岁的女性中，相应的风险差异为 0.07（每 1000 名女性中死亡人数差异，95%CI 为-0.93 至 1.3）（风险比为 1.00，95%CI 为 0.83 至 1.19）。
可用的 Medicare 数据仅允许在筛查后进行 8 年的随访。与任何使用观察性数据的研究一样，这些估计可能会受到残余混杂因素的影响。
与停止筛查相比，在 75 岁以上继续每年进行乳腺癌筛查并未显著降低 8 年乳腺癌死亡率。
美国国立卫生研究院。
