[参加弗留利-威尼斯朱利亚（意大利北部）乳腺钼靶筛查项目对晚期乳腺癌发病率的早期影响：一项队列研究]

[Early effects of attendance to the Friuli Venezia Giulia (Northern Italy) mammography screening programme on the incidence of advanced-stage breast cancer: a cohort study].

作者信息

Giudici Fabiola, Bortul Marina, Clagnan Elena, Del Zotto Stefania, Franzo Antonella, Giordano Livia, Gobbato Michele, Puliti Donella, Serraino Diego, Zucchetto Antonella, Zanier Loris, Zanconati Fabrizio, Bucchi Lauro

机构信息

Unità di biostatistica, epidemiologia e sanità pubblica, Università di Padova.

Unità di biostatistica, Dipartimento di scienze mediche, Università degli Studi di Trieste.

出版信息

Epidemiol Prev. 2020 Mar-Jun;44(2-3):145-153. doi: 10.19191/EP20.2-3.P145.037.

DOI:10.19191/EP20.2-3.P145.037

PMID:32631014

Abstract

OBJECTIVES

to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy) screening programme compared to women who did not attend.

DESIGN

retrospective cohort study. Women invited to the first screening round (2006-2007) were identified from the database of the programme. The cohort was record-linked to the archive of women invited to the second round (2008-2009). The definition of attendance to screening was based on attendance to at least one of the two rounds. The incidence of BC was assessed through record linkage with the FVG cancer registry using an anonymous univocal identifier (end of follow-up: 31st December 2013). Three distinct definitions of advanced stage were used: pT2 or greater (pT2+), positive lymph nodes (pN+), and TNM stage II or greater (stage II+).

SETTING AND PARTICIPANTS

organized mammography screening programme for women aged 50-69 years in the five regional healthcare districts.

MAIN OUTCOME MEASURES

incidence rate ratio (IRR) between attenders and non-attenders, adjusted for age and deprivation index, with 95% confidence interval (95%CI).

RESULTS

the cohort included 104,488 attenders and 49,839 non-attenders. During follow-up (median duration 84 months), 2,717 invasive BCs were diagnosed among attenders and 1,149 among non-attenders. Total incidence rate was 13% higher among attenders (IRR 1.13; 95%CI 1.05-1.21). These, conversely, had a 36% lower rate of pT2+ BC (IRR 0.64; 95%CI 0.56-0.72), a 13% lower rate of pN+ BC (IRR 0.87; 95%CI 0.78-0.98), a 22% lower rate of stage II+ BC (IRR 0.78; 95%CI 0.70-0.87), and a 32% lower rate of mastectomy (IRR 0.68; 95%CI 0.60-0.78).

CONCLUSIONS

attenders had lower incidence rates of advanced-stage BC. This early effect is suggestive of a future impact of the screening programme on BC mortality.

摘要

目的

评估参加弗留利-威尼斯朱利亚（FVG）地区（意大利北部）筛查项目的女性与未参加者相比，晚期乳腺癌（BC）的发病率——这是乳腺钼靶筛查效果的一个早期替代指标。

设计

回顾性队列研究。从项目数据库中识别出被邀请参加第一轮筛查（2006 - 2007年）的女性。该队列与被邀请参加第二轮筛查（2008 - 2009年）的女性档案进行记录关联。筛查参与的定义基于参加两轮筛查中的至少一轮。通过使用匿名唯一标识符与FVG癌症登记处进行记录关联来评估BC的发病率（随访截止日期：2013年12月31日）。使用了三种不同的晚期定义：pT2及以上（pT2+）、阳性淋巴结（pN+）以及TNM分期II及以上（II期+）。

设置和参与者

在五个地区医疗区为50 - 69岁女性组织的乳腺钼靶筛查项目。

主要观察指标

调整年龄和贫困指数后，参加者与未参加者之间的发病率比（IRR）及95%置信区间（95%CI）。

结果

该队列包括104,488名参加者和49,839名未参加者。在随访期间（中位时长84个月），参加者中诊断出2,717例浸润性BC，未参加者中诊断出1,149例。参加者的总发病率高13%（IRR 1.13；95%CI 1.05 - 1.21）。相反，参加者的pT2+ BC发病率低36%（IRR 0.64；95%CI 0.56 - 0.72），pN+ BC发病率低13%（IRR 0.87；95%CI 0.78 - 0.98），II期+ BC发病率低22%（IRR 0.78；95%CI 0.70 - 0.87），乳房切除术率低32%（IRR 0.68；95%CI 0.60 - 0.78）。