Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Preventive Medicine and Public Health Training Unit, Parc de Salut Mar-Pompeu Fabra University-Agència de Salut Pública de Barcelona (PSMar-UPF-ASPB), Barcelona, Spain.
Womens Health (Lond). 2020 Jan-Dec;16:1745506520965899. doi: 10.1177/1745506520965899.
Population-wide mammographic screening programs aim to reduce breast cancer mortality. However, a broad view of the harms and benefits of these programs is necessary to favor informed decisions, especially in the earliest stages of the disease. Here, we compare the outcomes of patients diagnosed with breast ductal carcinoma in situ in participants and non-participants of a population-based mammographic screening program.
A retrospective cohort study of all patients diagnosed with breast ductal carcinoma in situ between 2000 and 2010 within a single hospital. A total of 211 patients were included, and the median follow-up was 8.4 years. The effect of detection mode (screen-detected and non-screen-detected) on breast cancer recurrences, readmissions, and complications was evaluated through multivariate logistic regression analysis.
In the majority of women, breast ductal carcinoma in situ was screen-detected (63.5%). Screen-detected breast ductal carcinoma in situ was smaller in size compared to those non-screen-detected (57.53% < 20 mm versus 78.03%, p = 0.002). Overall, breast-conserving surgery was the most frequent surgery (86.26%); however, mastectomy was higher in non-screen-detected breast ductal carcinoma in situ (20.78% versus 9.7%, p = 0.024). Readmissions for mastectomy were more frequent in non-screen-detected breast ductal carcinoma in situ. Psychological complications, such as fatigue, anxiety, and depression, had a prevalence of 15% within our cohort. Risk of readmissions and complications was higher within the non-screen-detected group, as evidenced by an odds ratio = 6.25 (95% confidence interval = 1.95-19.99) for readmissions and an odds ratio = 2.41 (95% confidence interval = 1.95-4.86) for complications.
Our findings indicate that women with breast ductal carcinoma in situ breast cancer diagnosed through population-based breast cancer screening program experience a lower risk of readmissions and complications than those diagnosed outside these programs. These findings can help aid women and health professionals make informed decisions regarding screening.
人群范围的乳腺筛查项目旨在降低乳腺癌死亡率。然而，为了做出明智的决策，需要全面了解这些项目的危害和益处，尤其是在疾病的早期阶段。在这里，我们比较了参加和未参加人群为基础的乳腺筛查项目的患者在诊断为乳腺导管原位癌后的结局。
这是一项对 2000 年至 2010 年间在一家医院内诊断为乳腺导管原位癌的所有患者进行的回顾性队列研究。共纳入 211 例患者，中位随访时间为 8.4 年。通过多变量逻辑回归分析评估了检测模式（筛查检出和非筛查检出）对乳腺癌复发、再入院和并发症的影响。
在大多数女性中，乳腺导管原位癌为筛查检出（63.5%）。与非筛查检出相比，筛查检出的乳腺导管原位癌体积较小（57.53%<20mm 比 78.03%，p=0.002）。总体而言，保乳手术最常见（86.26%）；然而，非筛查检出的乳腺导管原位癌中，乳房切除术更高（20.78%比 9.7%，p=0.024）。非筛查检出的乳腺导管原位癌患者再入院行乳房切除术的频率更高。在我们的队列中，疲劳、焦虑和抑郁等心理并发症的患病率为 15%。非筛查检出组的再入院和并发症风险更高，再入院的优势比为 6.25（95%置信区间 1.95-19.99），并发症的优势比为 2.41（95%置信区间 1.95-4.86）。
我们的研究结果表明，通过人群为基础的乳腺癌筛查项目诊断为乳腺导管原位癌的女性再入院和并发症的风险低于未通过这些项目诊断的女性。这些发现可以帮助女性和卫生专业人员做出关于筛查的知情决策。
