Breast Unit - Radiology Service, Virgen de la Salud Hospital, Toledo, Spain.
Breast Unit - Surgery Service, Virgen de la Salud Hospital, Toledo, Spain.
J Med Screen. 2021 Dec;28(4):456-463. doi: 10.1177/09691413211002556. Epub 2021 Mar 29.
To assess screening quality metrics and to describe mortality rates eight years after redesign of breast cancer screening and diagnosis pathways, and the introduction of digital breast tomosynthesis.
Breast Unit of the Toledo Health Area in the region of Castilla-La Mancha (Spain).
We recorded screening metrics and mortality data following the introduction of digital breast tomosynthesis in 2011 for screening and diagnosis pathways. We then compared the mortality between Toledo Health Area and the rest of Castilla-La Mancha, where digital breast tomosynthesis is not available.
All screening quality metrics improved following the introduction of digital breast tomosynthesis. The cancer detection rate significantly increased from 2.3 (95% confidence interval (CI): 1.9-3.6) to 4.5 per 1000 women (95% CI: 3.2-5.2) on average between the periods 2005-2009 and 2015-2018, while the recall rate significantly decreased from 7.0% (95% CI: 6.8%-8.2%) to 2.6% (95% CI: 2.0%-3.6%). Comparing breast cancer mortality rates for 2014-2018 in the Toledo Health Area with the rest of Castilla-La Mancha, which had similar cancer treatment access and management protocols but without digital breast tomosynthesis, the crude mortality rate was 17.79 (95% CI: 15.38 -20.19) vs. 24.76 per 100,000 (95% CI: 26.12-23.39), respectively. The cumulative risk of death was also significantly lower for the Toledo Health Area than for Castilla-La Mancha.
The introduction of digital breast tomosynthesis improved screening quality indicators. Breast cancer mortality simultaneously decreased with respect to the rest of Castilla-La Mancha. Further research is needed to assess the long-term results, and the role that the redesign may have played in reducing mortality.
评估筛查质量指标，并描述乳腺癌筛查和诊断途径重新设计以及引入数字乳腺断层合成后 8 年的死亡率，以及引入数字乳腺断层合成后的死亡率。
卡斯蒂利亚-拉曼恰地区托莱多卫生区的乳腺科。
我们记录了数字乳腺断层合成引入后的筛查指标和死亡率数据，用于筛查和诊断途径。然后，我们将托莱多卫生区与没有数字乳腺断层合成的卡斯蒂利亚-拉曼恰其他地区进行了比较。
数字乳腺断层合成引入后，所有筛查质量指标均有所提高。癌症检出率从 2005-2009 年至 2015-2018 年期间的每 1000 名女性 2.3（95%置信区间（CI）：1.9-3.6）显著增加到每 1000 名女性 4.5（95%CI：3.2-5.2），而召回率从 7.0%（95%CI：6.8%-8.2%）显著下降至 2.6%（95%CI：2.0%-3.6%）。比较 2014-2018 年托莱多卫生区与具有相似癌症治疗途径和管理方案但没有数字乳腺断层合成的卡斯蒂利亚-拉曼恰其他地区的乳腺癌死亡率，托莱多卫生区的粗死亡率为 17.79（95%CI：15.38-20.19）与每 100000 人 24.76（95%CI：26.12-23.39）相比，粗死亡率分别为 17.79（95%CI：15.38-20.19）和 24.76（95%CI：26.12-23.39）。托莱多卫生区的累积死亡风险也明显低于卡斯蒂利亚-拉曼恰。
数字乳腺断层合成的引入提高了筛查质量指标。与卡斯蒂利亚-拉曼恰其他地区相比，乳腺癌死亡率同时下降。需要进一步研究以评估长期结果，以及重新设计可能在降低死亡率方面的作用。
