Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
JAMA Netw Open. 2022 Nov 1;5(11):e2241441. doi: 10.1001/jamanetworkopen.2022.41441.
Although current guidelines highlight the need for earlier screening in women at increased risk of breast cancer in China, data on risk-adapted starting ages of screening are limited.
To explore the risk-adapted starting age of breast cancer screening in China, with comprehensive consideration of breast cancer risk factors.
DESIGN, SETTING, AND PARTICIPANTS: A multicenter community-based cohort study was conducted under the framework of the Cancer Screening Program in Urban China. Data were collected from January 1, 2013, to December 31, 2018, for unscreened community-dwelling women aged 40 to 74 years without a history of cancer, kidney dysfunction, or severe heart, brain, or lung disease. Data analysis was performed from October 1, 2021, to August 16, 2022.
Baseline characteristics associated with breast cancer, including first-degree family history of breast cancer, benign breast disease, breastfeeding, age at menarche, and body mass index.
Outcomes included breast cancer diagnosis and age at diagnosis. Risk-adapted starting age of screening was defined as the age at which women with different levels of breast cancer risk attained a 10-year cumulative risk level similar to women aged 50 years in the general population.
Of the 1 549 988 women enrolled in this study, 3895 had breast cancer (median follow-up, 4.47 [IQR, 3.16-6.35] years). Participants were divided into different risk groups according to breast cancer risk scores (driven by risk factors including first-degree family history of breast cancer, benign breast disease, breastfeeding, age at menarche, and body mass index). Using the 10-year cumulative risk of breast cancer at age 50 years in the general population as a benchmark (2.65% [95% CI, 2.50%-2.76%]), the optimal starting age of screening for women with high, medium, or low risk of breast cancer was identified as 43, 48, or after 55 years, respectively. An online calculator was developed to calculate an individual's optimal starting age of screening.
This study identifies the risk-adapted starting age of breast cancer screening based on the principle of equal management of equal risks, which may inform updates of current screening guidelines.
尽管目前的指南强调了在中国乳腺癌高危女性中进行更早筛查的必要性，但有关风险适应筛查起始年龄的数据有限。
综合考虑乳腺癌危险因素，探讨中国乳腺癌风险适应筛查起始年龄。
设计、地点和参与者：本研究为城市中国癌症筛查计划框架下的一项多中心社区为基础的队列研究。数据收集自 2013 年 1 月 1 日至 2018 年 12 月 31 日，纳入年龄在 40 至 74 岁之间、无癌症病史、肾功能不全或严重心、脑、肺疾病的未筛查社区居民。数据分析于 2021 年 10 月 1 日至 2022 年 8 月 16 日进行。
与乳腺癌相关的基线特征，包括一级亲属乳腺癌家族史、良性乳腺疾病、母乳喂养、初潮年龄和体重指数。
结局包括乳腺癌诊断和诊断年龄。风险适应筛查起始年龄定义为，具有不同乳腺癌风险水平的女性达到与一般人群中 50 岁女性相似的 10 年累积风险水平的年龄。
本研究共纳入 1549988 名女性，其中 3895 人患有乳腺癌（中位随访时间，4.47[IQR，3.16-6.35]年）。参与者根据乳腺癌风险评分（由一级亲属乳腺癌家族史、良性乳腺疾病、母乳喂养、初潮年龄和体重指数等因素驱动）分为不同风险组。以一般人群中 50 岁时的乳腺癌 10 年累积风险（2.65%[95%CI，2.50%-2.76%]）为基准，高、中、低乳腺癌风险女性的最佳筛查起始年龄分别确定为 43、48 和 55 岁以上。还开发了一个在线计算器，用于计算个体的最佳筛查起始年龄。
本研究基于同等风险管理同等风险的原则确定了乳腺癌筛查的风险适应起始年龄，这可能为更新当前筛查指南提供信息。
