Cancer Council Queensland, Brisbane, Australia.
School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia.
Breast Cancer Res Treat. 2020 Dec;184(3):937-950. doi: 10.1007/s10549-020-05905-x. Epub 2020 Sep 14.
This study explores factors that are associated with the severity of breast cancer (BC) at diagnosis.
Interviews were conducted among women (n = 3326) aged 20-79 diagnosed with BC between 2011 and 2013 in Queensland, Australia. High-severity cancers were defined as either Stage II-IV, Grade 3, or having negative hormone receptors at diagnosis. Logistic regression models were used to estimate odds ratios (ORs) of high severity BC for variables relating to screening, lifestyle, reproductive habits, family history, socioeconomic status, and area disadvantage.
Symptom-detected women had greater odds (OR 3.38, 2.86-4.00) of being diagnosed with high-severity cancer than screen-detected women. Women who did not have regular mammograms had greater odds (OR 1.78, 1.40-2.28) of being diagnosed with high-severity cancer than those who had mammograms biennially. This trend was significant in both screen-detected and symptom-detected women. Screen-detected women who were non-smokers (OR 1.77, 1.16-2.71), postmenopausal (OR 2.01, 1.42-2.84), or employed (OR 1.46, 1.15-1.85) had greater odds of being diagnosed with high-severity cancer than those who were current smokers, premenopausal, or unemployed. Symptom-detected women being overweight (OR 1.67, 1.31-2.14), postmenopausal (OR 2.01, 1.43-2.82), had hormone replacement therapy (HRT) < 2 years (OR 1.60, 1.02-2.51) had greater odds of being diagnosed with high-severity cancer than those of healthy weight, premenopausal, had HRT > 10 years.
Screen-detected women and women who had mammograms biennially had lower odds of being diagnosed with high-severity breast cancer, which highlighted the benefit of regular breast cancer screening. Women in subgroups who are more likely to have more severe cancers should be particularly encouraged to participate in regular mammography screening.
本研究旨在探讨与乳腺癌（BC）诊断时严重程度相关的因素。
对 2011 年至 2013 年间在澳大利亚昆士兰州被诊断为 BC 的 3326 名 20-79 岁的女性进行了访谈。高危乳腺癌定义为 II-IV 期、3 级或诊断时无激素受体阴性。采用 logistic 回归模型估计与筛查、生活方式、生殖习惯、家族史、社会经济地位和地区劣势相关的变量对高危 BC 的比值比（OR）。
有症状的女性比筛查发现的女性更有可能被诊断为高危癌症（OR 3.38，2.86-4.00）。未定期进行乳房 X 线检查的女性比每两年进行一次乳房 X 线检查的女性更有可能被诊断为高危癌症（OR 1.78，1.40-2.28）。这种趋势在筛查发现和有症状的女性中均显著。未吸烟（OR 1.77，1.16-2.71）、绝经后（OR 2.01，1.42-2.84）或就业（OR 1.46，1.15-1.85）的筛查发现的女性比目前吸烟、绝经前或失业的女性更有可能被诊断为高危癌症。超重（OR 1.67，1.31-2.14）、绝经后（OR 2.01，1.43-2.82）、使用激素替代疗法（HRT）<2 年（OR 1.60，1.02-2.51）的有症状女性比体重健康、绝经前、HRT>10 年的女性更有可能被诊断为高危癌症。
筛查发现的女性和每两年进行一次乳房 X 线检查的女性被诊断为高危乳腺癌的几率较低，这突显了定期进行乳腺癌筛查的益处。应特别鼓励处于更有可能患有严重癌症亚组的女性定期接受乳房 X 线筛查。
