Centre for Cancer Prevention, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Department of Mammography, Falun Central Hospital, Falun, Sweden.
Cancer. 2020 Jul 1;126(13):2971-2979. doi: 10.1002/cncr.32859. Epub 2020 May 11.
It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.
Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.
Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51-0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66-0.84 [P < .001]).
Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
评估参与组织的乳房 X 光筛检服务对乳腺癌治疗变化的独立影响至关重要。这可以通过测量致命性乳腺癌的发病率来实现，其基于诊断日期而不是死亡日期。
在约占瑞典筛查合格人群 30%的 549091 名女性中，作者计算了 2473 例在诊断后 10 年内致命的乳腺癌和 9737 例晚期乳腺癌的发病率。关于每个乳腺癌诊断以及每个乳腺癌病例的死因和死亡日期的数据均从瑞典全国性登记处收集。肿瘤特征从地区癌症中心收集。关于邀请和参与的汇总数据由 Sectra Medical Systems AB 提供。使用泊松回归分析发病率。
参加乳房 X 光筛检的女性在 10 年内死于乳腺癌的风险显著降低了 41%（相对风险，0.59；95%置信区间，0.51-0.68[P<0.001]），晚期乳腺癌的发病率降低了 25%（相对风险，0.75；95%置信区间，0.66-0.84[P<0.001]）。
在这项对参加与不参加筛检的女性进行的同期比较中，发现诊断后 10 年内致命乳腺癌的发病率和晚期乳腺癌的发生率都显著降低。这些获益似乎独立于最近治疗方案的变化。
