Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2023 Nov 1;32(11):1542-1551. doi: 10.1158/1055-9965.EPI-23-0289.
We evaluated diagnostic mammography among women with a breast lump to determine whether performance varied across racial and ethnic groups.
This study included 51,014 diagnostic mammograms performed between 2005 and 2018 in the Breast Cancer Surveillance Consortium among Asian/Pacific Islander (12%), Black (7%), Hispanic/Latina (6%), and White (75%) women reporting a lump. Breast cancers occurring within 1 year were ascertained from cancer registry linkages. Multivariable regression was used to adjust performance statistic comparisons for breast cancer risk factors, mammogram modality, demographics, additional imaging, and imaging facility.
Cancer detection rates were highest among Asian/Pacific Islander [per 1,000 exams, 84.2 (95% confidence interval (CI): 72.0-98.2)] and Black women [81.4 (95% CI: 69.4-95.2)] and lowest among Hispanic/Latina women [42.9 (95% CI: 34.2-53.6)]. Positive predictive values (PPV) were higher among Black [37.0% (95% CI: 31.2-43.3)] and White [37.0% (95% CI: 30.0-44.6)] women and lowest among Hispanic/Latina women [22.0% (95% CI: 17.2-27.7)]. False-positive results were most common among Asian/Pacific Islander women [per 1,000 exams, 183.9 (95% CI: 126.7-259.2)] and lowest among White women [112.4 (95% CI: 86.1-145.5)]. After adjustment, false-positive and cancer detection rates remained higher for Asian/Pacific Islander and Black women (vs. Hispanic/Latina and White). Adjusted PPV was highest among Asian/Pacific Islander women.
Among women with a lump, Asian/Pacific Islander and Black women were more likely to have cancer detected and more likely to receive a false-positive result compared with White and Hispanic/Latina women.
Strategies for optimizing diagnostic mammography among women with a lump may vary by racial/ethnic group, but additional factors that influence performance differences need to be identified. See related In the Spotlight, p. 1479.
我们评估了女性乳房肿块的诊断性乳房 X 光检查，以确定不同种族和族裔群体的表现是否存在差异。
本研究纳入了 2005 年至 2018 年期间在乳腺癌监测联盟中进行的 51014 例诊断性乳房 X 光检查，这些女性均为亚裔/太平洋岛民（12%）、黑种人（7%）、西班牙裔/拉丁裔（6%）或白种人（75%），并自述有肿块。通过癌症登记处的链接确定了 1 年内发生的乳腺癌。多变量回归用于调整乳腺癌风险因素、乳房 X 光检查方式、人口统计学、额外影像学检查和影像学设施等因素对表现统计数据比较的影响。
亚洲/太平洋岛民女性的癌症检出率最高[每 1000 次检查中检出 84.2 例（95%置信区间：72.0-98.2）]，黑种人女性次之[81.4（95% CI：69.4-95.2）]，西班牙裔/拉丁裔女性最低[42.9（95% CI：34.2-53.6）]。黑人[37.0%（95% CI：31.2-43.3）]和白人[37.0%（95% CI：30.0-44.6）]女性的阳性预测值（PPV）较高，而西班牙裔/拉丁裔女性的 PPV 最低[22.0%（95% CI：17.2-27.7）]。假阳性结果在亚洲/太平洋岛民女性中最为常见[每 1000 次检查中出现 183.9 例（95% CI：126.7-259.2）]，而白人女性中最为少见[112.4（95% CI：86.1-145.5）]。调整后，亚洲/太平洋岛民和黑种人女性的假阳性和癌症检出率仍高于西班牙裔/拉丁裔和白种人女性。调整后的 PPV 在亚洲/太平洋岛民女性中最高。
在有肿块的女性中，与白种人和西班牙裔/拉丁裔女性相比，亚洲/太平洋岛民和黑种人女性更有可能被检出癌症，也更有可能出现假阳性结果。
优化有肿块女性诊断性乳房 X 光检查的策略可能因种族/族裔群体而异，但需要确定影响表现差异的其他因素。另见相关的重点文章，第 1479 页。
