University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Draper Laboratory, Cambridge, Massachusetts.
Cancer. 2021 Sep 15;127(18):3334-3342. doi: 10.1002/cncr.33661. Epub 2021 Jun 1.
Identifying women at risk for advanced interval cancers would allow better targeting of mammography and supplemental screening. The authors assessed risk factors for advanced breast cancer within 2 years of a negative mammogram.
The authors included 293,520 negative mammograms performed from 2006 to 2015 among 74,736 women. Breast cancers were defined as advanced if they were >2 cm, were >1 cm and triple-negative or human epidermal growth factor receptor 2-positive, had positive lymph nodes, or were metastatic. Cox proportional hazards modeling was used to evaluate associations of age, breast density, menopause, mammogram type, prior breast biopsy, body mass index (BMI), and a family history of breast cancer with a cancer diagnosis within 2 years of a negative mammogram. Models were stratified by year since a negative mammogram.
Among 1345 breast cancers, 357 were advanced (26.5%), and 988 (73.5%) were at an early stage. Breast density, prior biopsy, and family history were associated with an increased risk of both advanced and early-stage cancers. Overweight and obese women had a 40% higher risk of early-stage cancer only in year 2 (overweight hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.19-1.67; P < .001; obese HR, 1.41; 95% CI, 1.17-1.70; P < .001). Obese women had a 90% increased risk of advanced cancer in year 1 (HR, 1.90; 95% CI, 1.14-3.18; P = .014), and both overweight and obese women had a 40% or greater increased risk in year 2 (overweight HR, 1.55; 95% CI, 1.14-2.07; P = .005; obese HR, 1.42; 95% CI, 1.00-2.01; P = .051).
A higher BMI was associated with an advanced breast cancer diagnosis within 2 years of a negative mammogram. These results have important implications for risk assessment, screening intervals, and use of supplemental screening.
识别有进展期间隔性乳腺癌风险的女性，可以更好地针对乳房 X 光摄影术和补充筛查进行定位。作者评估了 74736 名女性在 2006 年至 2015 年期间进行的 293520 次阴性乳房 X 光检查中，2 年内发生进展性乳腺癌的风险因素。
作者纳入了 293520 次阴性乳房 X 光检查，这些检查是在 74736 名女性中进行的，这些女性中 2006 年至 2015 年间有 1345 例乳腺癌患者，其中 357 例（26.5%）为进展性乳腺癌，988 例（73.5%）为早期乳腺癌。如果乳腺癌的直径>2cm，直径>1cm 且为三阴性或人表皮生长因子受体 2 阳性，有阳性淋巴结或转移性，则定义为进展性乳腺癌。采用 Cox 比例风险模型评估年龄、乳房密度、绝经、乳房 X 光摄影术类型、既往乳腺活检、体重指数（BMI）和乳腺癌家族史与阴性乳房 X 光检查后 2 年内癌症诊断之间的关联。按距阴性乳房 X 光检查的时间长短进行分层。
在 1345 例乳腺癌中，有 357 例（26.5%）为进展性乳腺癌，988 例（73.5%）为早期乳腺癌。乳房密度、既往活检和家族史与进展期和早期乳腺癌的风险均增加有关。超重和肥胖女性仅在第 2 年（超重 HR，1.41；95%CI，1.19-1.67；P<0.001；肥胖 HR，1.41；95%CI，1.17-1.70；P<0.001）发生早期乳腺癌的风险增加 40%。肥胖女性在第 1 年（HR，1.90；95%CI，1.14-3.18；P=0.014）发生进展性乳腺癌的风险增加 90%，超重和肥胖女性在第 2 年（超重 HR，1.55；95%CI，1.14-2.07；P=0.005；肥胖 HR，1.42；95%CI，1.00-2.01；P=0.051）发生进展性乳腺癌的风险增加 40%或更高。
较高的 BMI 与阴性乳房 X 光检查后 2 年内诊断出进展性乳腺癌有关。这些结果对风险评估、筛查间隔时间以及补充筛查的应用具有重要意义。
