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[2014 - 2019年北京城区乳腺癌筛查]

[Breast cancer screening in urban Beijing, 2014-2019].

作者信息

Yang L, Zhang X, Liu S, Li H C, Zhang Q, Wang N, Ji J F

机构信息

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing 100142, China.

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2020 Sep 6;54(9):974-980. doi: 10.3760/cma.j.cn112150-20200429-00663.

Abstract

To analyze the current status of breast cancer screening among females in Urban Beijing Cancer Screening Program, 2014-2019. Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program, women residences aged 40 to 69 were recruited from 80 streets in six districts of Beijing (Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan District) using cluster sampling method. General demographic information and potential risk factors, results of clinical examination and follow-up outcomes of the target population (diagnosed breast cancer or not) were collected using epidemiological questionnaire, risk evaluation, clinical examination using ultrasound and (or) joint screening with mammography and follow-up, respectively. Proportion of high-risk cases evaluated by the questionnaire, recall rate, proportion of cases with BI-RADS grade 3 and BI-RADS grade 4/5, proportion of the cases with stage 0 or I, incidence rate and cumulative incidence rate were calculated. Cox proportional hazard regression model was used to estimate the hazard ratio () and 95% confidence interval (95%) among females who experienced different screening scenario. A total of 53 916 women with the age of (57.2±7.3) completed high-risk assessment were included into analysis. The proportion of overweigh and obesity were 40.90% (22 053 cases) and 15.34% (8 270 cases), respectively. A total of 17 535 cases (32.52%) were evaluated as positive case detected by the questionnaire. The clinical recall rate was 47.64% (8 353 cases) among the high-risk females. The positive rate detected by ultrasound or mammography alone was 1.84% and 4.00%, while the suspicious positive detection rates were 14.50% and 17.83%, respectively. The positive rate and suspicious positive rate detected by joint screening using ultrasound and mammography were 5.44% and 27.74% respectively. In total, 252 cases were diagnosed with breast cancer after an average of 2.68 years follow-up. The incidence rate and cumulative incidence rate of breast cancer were 174.34/100 000 person years and 470/100 000, respectively. The early detection rate was 68.6% among the residences who received clinical examination. Compared with the negative residence evaluated by the questionnaire, the positive cases has a 55% higher risk of diagnosed with breast cancer (=1.55, 95%:1.20-2.00); Cases that recognized by baseline ultrasound and mammography joint screening as BI-RADS 4/5 and BI-RADS 3 have higher risk of diagnosed with breast cancer than that of with the results of BI-RADS 1-2, with the of 12.60 (95%:6.49-24.47) and 1.89 (0.93-3.83), respectively. Females with high risk of breast cancer in Beijing have a better recall rate of receiving the clinical screening examination. Joint using ultrasonography and mammography in breast cancer screening can improve the positive detection rate among high risk females.

摘要

分析2014 - 2019年北京市城市癌症筛查项目中女性乳腺癌筛查的现状。基于国家城市癌症筛查项目正在进行的癌症筛查项目,采用整群抽样方法,从北京市六个区(东城区、西城区、朝阳区、海淀区、丰台区和石景山区)的80条街道招募40至69岁的女性居民。分别通过流行病学调查问卷、风险评估、超声临床检查和(或)联合乳腺钼靶筛查及随访,收集目标人群(是否诊断为乳腺癌)的一般人口学信息、潜在危险因素、临床检查结果及随访结果。计算问卷评估的高危病例比例、召回率、BI - RADS 3级和BI - RADS 4/5级病例比例、0期或I期病例比例、发病率和累积发病率。采用Cox比例风险回归模型估计不同筛查方案女性的风险比(HR)和95%置信区间(95%CI)。共有53916名年龄为(57.2±7.3)岁完成高危评估的女性纳入分析。超重和肥胖比例分别为40.90%(22,053例)和15.34%(8,270例)。问卷评估为阳性的病例共17,535例(32.52%)。高危女性的临床召回率为47.64%(8,353例)。单独超声或乳腺钼靶检查的阳性率分别为1.84%和4.00%,可疑阳性检出率分别为14.50%和17.83%。超声和乳腺钼靶联合筛查的阳性率和可疑阳性率分别为5.44%和27.74%。经过平均2.68年的随访,共252例被诊断为乳腺癌。乳腺癌的发病率和累积发病率分别为174.34/10万人口年和470/10万。接受临床检查的居民中早期检出率为68.6%。与问卷评估为阴性的居民相比,阳性病例诊断为乳腺癌的风险高55%(HR = 1.55,95%CI:1.20 - 2.00);基线超声和乳腺钼靶联合筛查结果为BI - RADS 4/5和BI - RADS 3的病例诊断为乳腺癌的风险高于BI - RADS 1 - 2结果的病例,HR分别为12.60(95%CI:6.49 - 24.47)和1.89(0.93 - 3.83)。北京乳腺癌高危女性接受临床筛查检查的召回率较好。超声和乳腺钼靶联合用于乳腺癌筛查可提高高危女性的阳性检出率。

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