Ding Lilu, Greuter Marcel J W, Truyen Inge, Goossens Mathijs, Van der Vegt Bert, De Schutter Harlinde, Van Hal Guido, de Bock Geertruida H
Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, 2610 Antwerpen, Belgium.
Cancers (Basel). 2022 Oct 3;14(19):4831. doi: 10.3390/cancers14194831.
Screening program effectiveness is generally evaluated for breast cancer (BC) as one disease and without considering the regularity of participation, while this might have an impact on detection rate.
To evaluate the short-term effectiveness of a mammography screening program for the major molecular subtypes of invasive BC.
All women who participated in the screening program and were diagnosed with screen-detected or interval BC in Flanders were included in the study (2008-2018). Molecular subtypes considered were luminal and luminal-HER2-positive, human epidermal growth factor receptor 2-positive, and triple-negative BC (TNBC). The relationship between the BC stage at diagnosis (early (I-II) versus advanced (III-IV)) and the method of detection (screen-detected or interval) and the relationship between the method of detection and participation regularity (regular versus irregular) were evaluated by multi-variable logistic regression models. All models were performed for each molecular subtype and adjusted for age.
Among the 12,318 included women, BC of luminal and luminal-HER2-positive subtypes accounted for 70.9% and 11.3%, respectively. Screen-detected BC was more likely to be diagnosed at early stages than interval BC with varied effect sizes for luminal, luminal-HER2-positive, and TNBC with OR:2.82 (95% CI: 2.45-3.25), OR:2.39 (95% CI: 1.77-3.24), and OR:2.29 (95% CI: 1.34-4.05), respectively. Regular participation was related to a higher likelihood of screening detection than irregular participation for luminal, luminal-HER2-positive, and TNBC with OR:1.21 (95% CI: 1.09-1.34), OR: 1.79 (95% CI: 1.38-2.33), and OR: 1.62 (95% CI: 1.10-2.41), respectively.
Regular screening as compared to irregular screening is effective for all breast cancers except for the HER2 subtype.
乳腺癌筛查项目的有效性通常作为一种疾病来评估，且未考虑参与的规律性，而这可能会对检出率产生影响。
评估乳腺钼靶筛查项目对浸润性乳腺癌主要分子亚型的短期有效性。
纳入所有参与筛查项目并在佛兰德被诊断为筛查发现或间隔期乳腺癌的女性（2008 - 2018年）。所考虑的分子亚型包括管腔型和管腔-HER2阳性型、人表皮生长因子受体2阳性型以及三阴性乳腺癌（TNBC）。通过多变量逻辑回归模型评估诊断时乳腺癌分期（早期（I - II期）与晚期（III - IV期））与检测方法（筛查发现或间隔期）之间的关系，以及检测方法与参与规律性（规律与不规律）之间的关系。所有模型针对每种分子亚型进行，并对年龄进行了调整。
在纳入的12318名女性中，管腔型和管腔-HER2阳性型乳腺癌分别占70.9%和11.3%。筛查发现的乳腺癌比间隔期乳腺癌更有可能在早期被诊断，管腔型、管腔-HER2阳性型和TNBC的效应大小各不相同，其比值比分别为：2.82（95%置信区间：2.45 - 3.25）、2.39（95%置信区间：1.77 - 3.24）和2.29（95%置信区间：1.34 - 4.05）。对于管腔型、管腔-HER2阳性型和TNBC，规律参与与筛查发现的可能性更高相关，其比值比分别为：1.21（95%置信区间：1.09 - 1.34）、1.79（95%置信区间：1.38 - 2.33）和1.62（95%置信区间：1.10 - 2.41）。
与不规律筛查相比，规律筛查对除HER2亚型外的所有乳腺癌均有效。
