Weigel Stefanie, Heindel Walter, Dietz Caroline, Meyer-Johann Ulrike, Graewingholt Axel, Hense Hans Werner
Institute of Clinical Radiology and Reference Center for Mammography Münster, University and University Hospital Münster, Germany.
Screening Unit, Leverkusen, Germany.
Rofo. 2020 Jul;192(7):678-685. doi: 10.1055/a-1100-0016. Epub 2020 Feb 27.
Analysis of the influence of the singular risk factors age and breast density on the 2-year incidence of breast cancer among participants in the German mammography screening program.
The multicenter study includes 111 456 subsequent round digital mammographic screening examinations from four screening units with prospective visual categorization of breast density. Based on detection in screening and during the 2-year interval after negative screening participation (interval cancers), 2-year breast cancer incidences (2 YBCI) (‰) were calculated in the 5-year age groups (5 YAG) of the target group 50-69 years and in the BI-RADS density categories ACR 1-4. Multivariate statistical evaluations were carried out using logistic regression models.
With an increase in the 5 YAG, the 2 YBCI increased by 5.0 ‰, 6.7 ‰, 8.5 ‰ to 9.7 ‰, and was significantly different among 55-59, 60-64 and 65-69-year-old women compared to the youngest reference group 50-54 years (odds ratio (OR): 1.34; 1.68; and 1.93; p-value < 0.0001). With an increase in density categories 1-4, the 2 YBCI increased from 2.6 ‰, to 5.8 ‰, 9.6 ‰, and 9.7 ‰. The 2 YBCI differed significantly in breast density categories 2, 3, 4 from reference group 1 (OR: 2.17; 3.65; and 3.76; p-value < 0.0001). Only within the two main breast density groups 2 (frequency 44.3 %) and 3 (44.7 %), a significant increase in the 2 YBCI was observed across the 5 YAG (category 2: 3.7-8.9 ‰; category 3: 5.8-11.7 ‰; p-value < 0.001 each). The 2 YBCI was above the median of 7.5 ‰ in women with breast density category 2 and aged 65-69 years, as well as in women with breast density categories 3 and 4 aged 55-69 years. A 2 YBCI below the median was seen in women between 50-54 years regardless of breast density, as well as women in category 1 in all age groups.
Within the main breast density categories 2 and 3 (almost 90 % of participants), incidences increase with age to double. A consistently low incidence is found regardless of breast density at a young screening age and in women with the lowest breast density.
· The risk of breast cancer is modified by age in density categories.. · Women aged 50-54 years have a low risk in all density categories.. · Women in category ACR 1 of any age group have a low risk..
· Weigel S, Heindel W, Dietz C et al. Stratifizierung des Brustkrebsrisikos hinsichtlich der Einflüsse von Alter und mammografischer Dichte. Fortschr Röntgenstr 2020; 192: 678 - 685.
分析年龄和乳腺密度等单一风险因素对德国乳腺X线筛查项目参与者中乳腺癌2年发病率的影响。
这项多中心研究包括来自四个筛查单位的111456例后续轮次数字化乳腺X线筛查检查，并对乳腺密度进行前瞻性视觉分类。基于筛查时及阴性筛查参与后的2年间隔期内（间期癌）的检测情况，计算了目标组50 - 69岁的5岁年龄组（5YAG）以及BI-RADS密度类别ACR 1 - 4中的2年乳腺癌发病率（2YBCI）（‰）。使用逻辑回归模型进行多变量统计评估。
随着5YAG的增加，2YBCI分别增加了5.0‰、6.7‰、8.5‰至9.7‰，与最年轻的参考组50 - 54岁相比，55 - 59岁、60 - 64岁和65 - 69岁女性之间存在显著差异（优势比（OR）：1.34；1.68；和1.93；p值<0.0001）。随着密度类别1 - 4的增加，2YBCI从2.6‰增加到5.8‰、9.6‰和9.7‰。乳腺密度类别2、3、4与参考组1的2YBCI存在显著差异（OR：2.17；3.65；和3.76；p值<0.0001）。仅在两个主要乳腺密度组2（频率44.3%）和3（44.7%）中，观察到整个5YAG中2YBCI有显著增加（类别2：3.7 - 8.9‰；类别3：5.8 - 11.7‰；每个p值<0.001）。乳腺密度类别2且年龄在65 - 69岁的女性以及乳腺密度类别3和4且年龄在55 - 69岁的女性的2YBCI高于中位数7.5‰。无论乳腺密度如何，50 - 54岁的女性以及所有年龄组中类别1的女性的2YBCI均低于中位数。
在主要乳腺密度类别2和3（几乎占参与者的90%）中，发病率随年龄增加而翻倍。在年轻筛查年龄以及乳腺密度最低的女性中，无论乳腺密度如何，发病率始终较低。
· 年龄在密度类别中会改变乳腺癌风险。· 50 - 54岁的女性在所有密度类别中风险较低。· 任何年龄组中ACR 1类别的女性风险较低。
· Weigel S, Heindel W, Dietz C等。关于年龄和乳腺X线密度影响的乳腺癌风险分层。Fortschr Röntgenstr 2020；192：678 - 685。
