Duffy Stephen W, Yen Amy Ming-Fang, Tabar Laszlo, Lin Abbie Ting-Yu, Chen Sam Li-Sheng, Hsu Chen-Yang, Dean Peter B, Smith Robert A, Chen Tony Hsiu-Hsi
Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
J Med Screen. 2024 Mar;31(1):3-7. doi: 10.1177/09691413231186686. Epub 2023 Jul 12.
The benefit of mammography screening in reducing population mortality from breast cancer is well established. In this paper, we estimate the effect of repeated participation at scheduled screens on case survival.
We analysed incidence and survival data on 37,079 women from nine Swedish counties who had at least one to five invitation(s) to screening prior to diagnosis, and were diagnosed with breast cancer between 1992 and 2016. Of these, 4564 subsequently died of breast cancer. We estimated the association of survival with participation in up to the most recent five screens before diagnosis. We used proportional hazards regression to estimate the effect on survival of the number of scheduled screens in which subjects participated prior to the diagnosis of breast cancer.
There was successively better survival with an increasing number of screens in which the subject participated. For a woman with five previous screening invitations who participated in all five, the hazard ratio was 0.28 (95% confidence interval (CI) 0.25-0.33, < 0.0001) compared to a woman attending none (86.9% vs 68.9% 20-year survival). Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, < 0.0001), an approximate three-fold reduction in the hazard of dying from breast cancer.
For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival.
乳腺钼靶筛查在降低乳腺癌人群死亡率方面的益处已得到充分证实。在本文中，我们估计了按计划重复参加筛查对病例生存的影响。
我们分析了来自瑞典9个县的37079名女性的发病和生存数据，这些女性在诊断前至少收到过一至五次筛查邀请，并于1992年至2016年期间被诊断为乳腺癌。其中，4564人随后死于乳腺癌。我们估计了生存与在诊断前参加最多最近五次筛查之间的关联。我们使用比例风险回归来估计在乳腺癌诊断前受试者参加的计划筛查次数对生存的影响。
随着受试者参加筛查次数的增加，生存率依次提高。对于之前收到过五次筛查邀请且全部参加的女性，与未参加任何筛查的女性相比，风险比为0.28（95%置信区间（CI）0.25 - 0.33，P < 0.0001）（20年生存率分别为86.9%和68.9%）。在对潜在的自我选择因素进行保守调整后，风险比为0.34（95% CI 0.26 - 0.43，P < 0.0001），死于乳腺癌的风险降低了约三倍。
对于那些患乳腺癌的女性，之前定期参加乳腺钼靶筛查可显著提高生存率。
