School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
ESMO Open. 2021 Jun;6(3):100111. doi: 10.1016/j.esmoop.2021.100111. Epub 2021 Apr 20.
Multiple studies over the past 4 decades have shown the significant benefit of breast cancer screening (BCS) in reducing mortality rates from breast cancer (BC). However, significant debate exists about the role of BCS in this regard, with some studies also showing no benefit in terms of mortality along with issues such as overdiagnosis, health care utilisation costs, psychological distress or overtreatment. To date, no BCS study has focused on disability. Hence the aim of this study is to evaluate the relative contribution of BCS approaches to age-standardized mortality and disability-adjusted life years (DALYs) rates along with other related risk factors, from a country-level perspective.
This study created a country-dataset by merging information from the Global Burden of Disease study regarding female age-standardized BC mortality, DALYs rates and other risk factors with the BCS programme availability at the national or regional level (versus no or only pilot such programme), BCS type (mammography, digital screening, breast self-examination and clinical breast examination) and other BCS-related information among 130 countries. Mixed-effect multilevel regression models were run to examine the associations of interest.
The most important factor predictive of lower mortality was the more advanced type of BCS programme availability [mammography: -4.16, 95% CI -6.76 to -1.55; digital mammography/ultrasound: -3.64, 95% CI -6.59 to -0.70] when compared with self- or clinical breast examinations. High levels of low-density lipoprotein cholesterol (LDL-c) and smoking were also related to higher mortality and DALYs from BC. In terms of BC DALYs, BCS had a 21.9 to 22.3-fold increase in the magnitude of effect compared with that in terms of mortality. Data on mortality and DALYs in relation to BCS programmes were also calculated for high-, middle- and low-income countries.
These data further support the positive effects of BCS in relation to age-standardized BC mortality rates, and for the first time show the impact of BCS on DALYs too. Additional factors, such as diabetes, high levels of LDL-c or smoking seemed to be related to BC mortality and disability, and could be considered as additional components of possible interventions to be used alongside BCS to optimize the BCS benefit on patients.
过去 40 多年的多项研究表明，乳腺癌筛查（BCS）在降低乳腺癌死亡率方面具有显著益处。然而，关于 BCS 在这方面的作用仍存在很大争议，一些研究表明死亡率方面没有获益，同时还存在过度诊断、医疗保健利用成本、心理困扰或过度治疗等问题。迄今为止，尚无 BCS 研究关注残疾问题。因此，本研究旨在从国家层面评估 BCS 方法对标准化年龄死亡率和伤残调整生命年（DALY）率的相对贡献，以及其他相关风险因素。
本研究通过合并全球疾病负担研究中有关女性年龄标准化乳腺癌死亡率、DALY 率和其他风险因素的信息，以及国家或地区一级的 BCS 计划的可用性（与没有或仅有试点计划相比）、BCS 类型（乳房 X 线照相术、数字筛查、乳房自我检查和临床乳房检查）以及 130 个国家的其他 BCS 相关信息，创建了一个国家数据集。采用混合效应多级回归模型来检验感兴趣的关联。
预测死亡率较低的最重要因素是更先进的 BCS 计划的可用性[乳房 X 线照相术：-4.16，95%置信区间（CI）为-6.76 至-1.55；数字乳房 X 线照相术/超声：-3.64，95%CI 为-6.59 至-0.70]，与自我或临床乳房检查相比。低密度脂蛋白胆固醇（LDL-c）水平高和吸烟也是与乳腺癌死亡率和 DALY 升高相关的因素。就乳腺癌 DALY 而言，BCS 的影响幅度比死亡率高 21.9 至 22.3 倍。还计算了高、中、低收入国家与 BCS 计划相关的死亡率和 DALY 数据。
这些数据进一步支持 BCS 对标准化乳腺癌死亡率的积极影响，并且首次显示了 BCS 对 DALY 的影响。其他因素，如糖尿病、LDL-c 水平高或吸烟，似乎与乳腺癌的死亡率和残疾有关，可被视为 BCS 之外的可能干预措施的附加组成部分，以优化 BCS 对患者的获益。
