Wu Haiyan, Wong Kwok, Lu Shou-En, Broggio John, Zhang Lanjing
Health Data Research UK London, UCL Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK.
National Cancer Registration and Analysis Service, Public Health England, Birmingham B3 2PW, UK.
J Clin Transl Pathol. 2022 Mar;2(1):23-30. doi: 10.14218/jctp.2022.00003. Epub 2022 Mar 18.
Uptake of breast cancer screening has been decreasing in England since 2007. However, the associated factors are unclear. On the other hand, survival among breast cancer patients have recently increased. We conducted a quasi-experimental analysis to test whether the trend-change in proportional incidence of non-screened cancers coincided with that in five-year net-survival.
We extracted population-based proportional incidence and age-standardized five-year net-survival data from Public Health England that included English women with invasive breast cancer diagnosed during 1995-2011 (linked to death certificates, followed through 2016). Piece-wise log-linear models with change-point/joinpoint were used to estimate temporal trends.
Among 254,063 women in England with invasive breast cancer diagnosed during 1995-2011, there was downward-to-upward trend-change in proportional incidence of non-screened breast cancers (annual percent change [APC]=5.6 after 2007 versus APC=-3.5 before 2007, <0.001) in diagnosis-year 2007, when a steeper upward-trend in age-standardized five-year net survival started (APC=5.7 after 2007/2008 versus APC=0.3 before 2007/2008, 0.001). Net-survival difference of screened versus non-screened cancers also significantly narrowed (18% in 2007/2008 versus 5% in 2011). Similar associations were found in all strata of race, cancer stage, grade, and histology, except in Black patients or patients with stage I, stage III, or grade I cancer.
There was a downward-to-upward trend-change in proportional incidence of non-screened breast cancers in 2007 that coincided with a steeper upward-trend in age-standardized five-year net survival among English women in 2007. Survival benefits of breast cancer screening decreased during 2007-2011. The data support reduction of breast cancer screening in some patients, but future validation studies are warranted.
自2007年以来，英格兰乳腺癌筛查的参与率一直在下降。然而，相关因素尚不清楚。另一方面，乳腺癌患者的生存率最近有所提高。我们进行了一项准实验分析，以检验未筛查癌症的比例发病率的趋势变化是否与五年净生存率的趋势变化一致。
我们从英国公共卫生部门提取了基于人群的比例发病率和年龄标准化的五年净生存率数据，这些数据包括1995 - 2011年期间诊断为浸润性乳腺癌的英国女性（与死亡证明相关联，随访至2016年）。使用带有变化点/连接点的分段对数线性模型来估计时间趋势。
在1995 - 2011年期间诊断为浸润性乳腺癌的254,063名英国女性中，2007年未筛查乳腺癌的比例发病率出现了从下降到上升的趋势变化（2007年后年度百分比变化[APC]=5.6，而2007年前APC=-3.5，<0.001），与此同时，年龄标准化的五年净生存率开始出现更陡峭的上升趋势（2007/2008年后APC=5.7，而2007/2008年前APC=0.3，0.001）。筛查癌症与未筛查癌症的净生存率差异也显著缩小（2007/2008年为18%，2011年为5%）。在所有种族、癌症分期、分级和组织学分层中均发现了类似的关联，但黑人患者或I期、III期或I级癌症患者除外。
2007年未筛查乳腺癌的比例发病率出现了从下降到上升的趋势变化，这与2007年英国女性年龄标准化的五年净生存率更陡峭的上升趋势一致。2007 - 2011年期间，乳腺癌筛查的生存获益有所下降。这些数据支持在某些患者中减少乳腺癌筛查，但未来需要进行验证研究。
