Kwon Mi-Ri, Chang Yoosoo, Park Boyoung, Ryu Seungho, Kook Shin Ho
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-Ro, Jongno-Gu, Seoul, 03181, Republic of Korea.
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-Ro 2Ga, Jung-Gu, Seoul, 04514, Republic of Korea.
Breast Cancer. 2023 Mar;30(2):241-248. doi: 10.1007/s12282-022-01414-5. Epub 2022 Nov 5.
Screening mammography performance among young women remains uncertain in East Asia, where the proportion of young breast cancer patients is higher than that in Western countries. Thus, we analyzed the performance of screening mammography in women under 40 years in comparison with older age groups.
This retrospective study comprised 95,431 Asian women with 197,525 screening mammograms. The reference standard was determined by linkage to the national cancer registry data and the 12-month follow-up outcomes after the index mammogram. The performance metrics included sensitivity, specificity, cancer detection rate (CDR), positive predictive value (PPV), recall rate, and areas under the receiver operating characteristic curve (AUCs), with comparisons across age groups (30 s, 40 s, and ≥ 50 s).
For young women aged < 40 years, sensitivity and AUC (95% confidence interval [CI]) of screening mammography were 60.4% (50.4-69.7) and 0.73 (0.68-0.77), respectively, with no significant difference compared to women in their 40 s (sensitivity: 64.0% [95% CI: 57.8-69.8], P = 0.52; AUC: 0.75 [95% CI: 0.73-0.78], P = 0.35). The CDR (95% CI) was 0.8 (0.6-1.1) per 1,000 mammograms for young women, poorer than 1.8 (1.6-2.1) per 1,000 mammograms for women in their 40 s (P < 0.001). The PPV and recall rate (95% CI) for young women were 0.6% (0.4-0.7) and 14.9% (14.6-15.1), poorer than 1.4% (1.2-1.6) and 13.3% (13.1-13.5) for women in their 40 s (P < 0.001), respectively.
The accuracy of screening mammography for young women in their 30 s was not significantly different from that for women in their 40 s, but the cancer detection and recall rates were poorer.
在东亚地区，年轻女性的乳腺钼靶筛查效果仍不明确，该地区年轻乳腺癌患者的比例高于西方国家。因此，我们分析了40岁以下女性乳腺钼靶筛查与年龄较大组相比的效果。
这项回顾性研究纳入了95431名亚洲女性的197525次乳腺钼靶筛查。参考标准通过与国家癌症登记数据及首次乳腺钼靶检查后12个月的随访结果相联系来确定。性能指标包括敏感性、特异性、癌症检出率（CDR）、阳性预测值（PPV）、召回率以及受试者操作特征曲线下面积（AUC），并对不同年龄组（30多岁、40多岁及≥50岁）进行比较。
对于年龄＜40岁的年轻女性，乳腺钼靶筛查的敏感性和AUC（95%置信区间[CI]）分别为60.4%（50.4 - 69.7）和0.73（0.68 - 0.77），与40多岁的女性相比无显著差异（敏感性：64.0%[95%CI：57.8 - 69.8]，P = 0.52；AUC：0.75[95%CI：0.73 - 0.78]，P = 0.35）。年轻女性每1000次乳腺钼靶检查的CDR（95%CI）为0.8（0.6 - 1.1），低于40多岁女性每1000次乳腺钼靶检查的1.8（1.6 - 2.1）（P < 0.001）。年轻女性的PPV和召回率（95%CI）分别为0.6%（0.4 - 0.7）和14.9%（14.6 - 15.1），低于40多岁女性的1.4%（1.2 - 1.6）和13.3%（13.1 - 13.5）（P < 0.001）。
30多岁年轻女性乳腺钼靶筛查的准确性与40多岁女性无显著差异，但癌症检出率和召回率较低。
