Weill Cornell Medicine, Department of Breast Surgery, 425 E. 61st St., 10th Floor, New York, NY 10065, USA.
Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA.
Clin Imaging. 2021 Dec;80:430-437. doi: 10.1016/j.clinimag.2021.08.013. Epub 2021 Aug 30.
Screening mammography improves breast cancer survival through early detection, but Triple Negative Breast Cancer (TNBC) is more difficult to detect on mammography and has lower survival compared to non-TNBC, even when detected at early stages. TNBC is twice as common among African American (AA) compared to White American (WA) women, thereby contributing to the 40% higher breast cancer mortality rates observed in AA women. The role of screening mammography in addressing breast cancer disparities is therefore worthy of study.
Outcomes were evaluated for TNBC patients treated in the prospectively-maintained databases of academic cancer programs in two metropolitan cities of the Northeast and Midwest, 1998-2018.
Of 756 TNBC cases, 301 (39.8%) were mammographically screen-detected. 46% of 189 AA and 38.5% of 460 WA patients had screen-detected TNBC (p = 0.16). 25.3% of 257 TNBC cases ≤50 years old had screen-detected disease compared to 47.3% of 499 TNBC cases >50 years old (p < 0.0001). 220/301 (73.1%) screen-detected TNBC cases were T1 lesions versus 118/359 (32.9%) non-screen-detected cases (p < 0.0001). Screen-detected TNBC was more likely to be node-negative (51.9% v. 40.4%; p < 0.0001). Five-year overall survival was better in screen-detected TNBC compared to nonscreen-detected TNBC (92.8% v. 81.5%; p < 0.0001) in the entire cohort. The magnitude of this effect was most significant among AA patients (Fig. 1). Screening-related survival patterns were similar among AA and WA patients in both cities.
Data from two different cities demonstrates the value of screening mammography to mitigate breast cancer disparities in AA women through the early detection of TNBC.
通过早期发现，筛查性乳房 X 光检查可提高乳腺癌的生存率，但三阴性乳腺癌（TNBC）在乳房 X 光检查中更难发现，并且与非 TNBC 相比，即使在早期发现，其生存率也较低。与美国白人（WA）女性相比，非洲裔美国（AA）女性中 TNBC 的发病率高两倍，这导致 AA 女性的乳腺癌死亡率高出 40%。因此，筛查性乳房 X 光检查在解决乳腺癌差异方面的作用值得研究。
对 1998 年至 2018 年在东北部和中西部两个大都市学术癌症项目的前瞻性维护数据库中治疗的 TNBC 患者的结局进行了评估。
在 756 例 TNBC 病例中，有 301 例（39.8%）经乳房 X 光筛查发现。189 例 AA 患者中有 46%（189 例中的 87 例）和 460 例 WA 患者中有 38.5%（460 例中的 174 例）经乳房 X 光筛查发现 TNBC（p=0.16）。25.3%的年龄≤50 岁的 257 例 TNBC 病例经筛查发现疾病，而 47.3%的年龄>50 岁的 499 例 TNBC 病例经筛查发现疾病（p<0.0001）。220/301（73.1%）经筛查发现的 TNBC 病例为 T1 病变，而 359 例非经筛查发现的 TNBC 病例中只有 118 例（32.9%）（p<0.0001）。经筛查发现的 TNBC 淋巴结阴性的可能性更大（51.9%比 40.4%；p<0.0001）。在整个队列中，与非经筛查发现的 TNBC 相比，经筛查发现的 TNBC 的 5 年总生存率更好（92.8%比 81.5%；p<0.0001）。在 AA 患者中，这种影响的幅度最大（图 1）。在两个城市中，AA 和 WA 患者的筛查相关生存模式相似。
来自两个不同城市的数据表明，通过早期发现 TNBC，筛查性乳房 X 光检查可在 AA 女性中减轻乳腺癌差异。
