Pelofi Guillaume, Martin Xavier, Barben Jérémy, Jouanny Pierre
Maison de santé, Montchanin, France
Hôpital Privé Sainte-Marie, Chalon-sur-Saône, France
Geriatr Psychol Neuropsychiatr Vieil. 2022 Jun 1;20(2):182-189. doi: 10.1684/pnv.2022.1035.
Organized breast cancer screening in France is recommended for women up to 74 years of age, while the frequency and severity of this cancer increases after 75 years. The aim of this work is to assess the potential benefits of extending organized screening.
Retrospective study of a continuous monocentric series of women over 75 having undergone surgery for breast cancer. The following variables were studied: addressing after screening or not, age at diagnosis, UICC stage and therapeutic measures (surgery by lumpectomy or mastectomy, lymph node dissection, adjuvant treatment with chemotherapy, radiotherapy or hormone therapy).
185 women aged 82.8 ± 5.2 years [extreme ages 75 to 95] were included in the study. 136 (73.5%) breast cancers were discovered after palpation and 49 (26.5%) after screening mammography. The distribution by stage was: I - 38.8%, II - 39.5%, III - 15.1% and stage IV - 7%. 164 (87.7%), patients received surgical treatment: 115 lumpectomies (61.2%) and 49 mastectomies (26.5%). 51 (27.6%) patients underwent lymph node dissection. The distribution of adjuvant treatments was: chemotherapy 21.1%, radiotherapy 68.6%, or hormone therapy (79.5%), sometimes combined. Women not screened are older than women screened (84 ± 5.3 versus 79.5 ± 3.6 years; p < 0.0001). Cancers are diagnosed at a more advanced stage in non-screened patients compared to screened patients (p < 0.0001). While there is a higher proportion of stage I among screened patients (75.5%), stage II is the most frequent in women not screened (47%). Stage I and II are the majority in the latter (72%). In multivariate analysis with adjustment for age, screening made it possible to make a diagnosis at a less advanced stage (stage I-II vs II-IV: OR = 5.593; 95% CI [1.575–19.866]; p = 0.0078) and to have conservative surgery more often (lumpectomy vs mastectomy: OR = 2.645; 95% CI [1.079–6.493]; p = 0.0333) without more recourse to surgery (OR = 1.856 95% CI [0.207–16.612]; p = 0.58). After adjusting for age and stage, screening was no longer a determining factor in the choice of type of surgery (OR = 1.934; 95% CI [0.753–4.975]; p = 0.170).
At the age when organized breast cancer screening in France stopped, there was a decrease in survival, a diagnosis at a higher stage and an increase in co-morbidities. Our study shows a change in management with heavier treatment, more complications and a greater loss of autonomy without screening. This pleads for a continuation beyond 75 years of the practice of mammography screening for breast cancer in elderly women.
法国建议对74岁及以下女性进行有组织的乳腺癌筛查，而75岁以后这种癌症的发病率和严重程度会增加。这项研究的目的是评估扩大有组织筛查的潜在益处。
对一组连续的、在同一中心接受乳腺癌手术的75岁以上女性进行回顾性研究。研究了以下变量：筛查后就诊情况、诊断时年龄、国际抗癌联盟（UICC）分期以及治疗措施（保乳手术或乳房切除术、淋巴结清扫术、化疗、放疗或激素治疗等辅助治疗）。
185名年龄为82.8±5.2岁[年龄范围75至95岁]的女性纳入研究。136例（73.5%）乳腺癌是在触诊后发现的，49例（26.5%）是在乳腺钼靶筛查后发现的。分期分布为：I期 - 38.8%，II期 - 39.5%，III期 - 15.1%，IV期 - 7%。164例（87.7%）患者接受了手术治疗：115例保乳手术（61.2%）和49例乳房切除术（26.5%）。51例（27.6%）患者接受了淋巴结清扫术。辅助治疗的分布为：化疗21.1%，放疗68.6%，或激素治疗（79.5%），有时联合使用。未接受筛查的女性比接受筛查的女性年龄更大（84±5.3岁对79.5±3.6岁；p<0.0001）。与接受筛查的患者相比，未接受筛查的患者癌症诊断时分期更晚（p<0.0001）。接受筛查的患者中I期比例更高（75.5%），而未接受筛查的女性中II期最常见（47%）。I期和II期在后者中占多数（72%）。在对年龄进行调整的多因素分析中，筛查使得能够在较早期进行诊断（I-II期对II-IV期：比值比（OR）=5.593；95%置信区间[1.575 - 19.866]；p = 0.0078），并且更常进行保乳手术（保乳手术对乳房切除术：OR = 2.645；95%置信区间[1.079 - 6.493]；p = 0.0333），但手术总需求并未增加（OR = 1.856，95%置信区间[0.207 - 16.612]；p = 0.58）。在对年龄和分期进行调整后，筛查不再是手术类型选择的决定因素（OR = 1.934；95%置信区间[0.753 - 4.975]；p = 0.170）。
在法国停止有组织的乳腺癌筛查的年龄阶段，生存率下降，诊断分期更高，合并症增加。我们的研究表明，未进行筛查时治疗更繁重、并发症更多且自主性丧失更大，治疗管理发生了变化。这支持在老年女性中继续对75岁以上女性进行乳腺癌钼靶筛查。
