Choi Eunji, Jun Jae Kwan, Suh Mina, Jung Kyu-Won, Park Boyoung, Lee Kyeongmin, Jung So-Youn, Lee Eun Sook, Choi Kui Son
Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
NPJ Breast Cancer. 2021 Jun 28;7(1):83. doi: 10.1038/s41523-021-00295-9.
High incidences of breast cancer (BC) are reported in Asian women in their forties, and it is not clear whether mammographic screening reduces mortality among them. This study evaluated the effect of BC screening on mortality in Korea. We conducted a nationwide prospective cohort study of women invited to the Korean National Cancer Screening Program (KNCSP) between 2002 and 2003 (N = 8,300,682), with data linkage to the Korea Central Cancer Registry and death certificates through 2014 and 2015, respectively. Exposure to mammographic screening was defined using a modified never/ever approach. The primary study outcome was adjusted mortality rate ratio (MRR) for BC among screened and non-screened women estimated by Poisson regression. An adjusted MRR for all cause-death other than BC was examined to account for selection bias in the cohort. BC incidence rates for screened and non-screened women were 84.41 and 82.88 per 100,000 women-years, respectively. BC mortality rates for screened and non-screened women were 5.81 and 13.43 per 100,000 women-years, respectively, with an adjusted MRR for BC of 0.43 (95% CI, 0.41-0.44). The adjusted MRR for all-cause death excluding BC was 0.52 (95% CI, 0.52-0.52). The greatest reduction in BC mortality was noted for women aged 45-54 years, and there was no observable reduction in mortality after the age of 70 years. In conclusion, the KNCSP has been effective in reducing BC mortality among Korean women aged 40-69 years.
据报道，亚洲40多岁的女性乳腺癌（BC）发病率很高，目前尚不清楚乳腺钼靶筛查是否能降低她们的死亡率。本研究评估了韩国BC筛查对死亡率的影响。我们对2002年至2003年期间受邀参加韩国国家癌症筛查计划（KNCSP）的女性进行了一项全国性前瞻性队列研究（N = 8,300,682），数据分别与韩国中央癌症登记处和2014年及2015年的死亡证明相链接。乳腺钼靶筛查的暴露情况采用改良的从不/曾经接受筛查的方法进行定义。主要研究结局是通过泊松回归估计的筛查和未筛查女性中BC的调整死亡率比（MRR）。对除BC以外的所有原因死亡的调整MRR进行了检查，以考虑队列中的选择偏倚。筛查和未筛查女性的BC发病率分别为每10万女性年84.41例和82.88例。筛查和未筛查女性的BC死亡率分别为每10万女性年5.81例和13.43例，BC的调整MRR为0.43（95%CI，0.41 - 0.44）。排除BC后的全因死亡调整MRR为0.52（95%CI，0.52 - 0.52）。45 - 54岁的女性BC死亡率下降最为显著，70岁以后死亡率没有明显下降。总之，KNCSP在降低40 - 69岁韩国女性的BC死亡率方面是有效的。
