HealthStat Consulting, Inc., Seattle, Washington, USA.
School of Public Health, University of Washington, Seattle, Washington, USA.
Cancer. 2023 Dec 15;129(24):3862-3872. doi: 10.1002/cncr.34973. Epub 2023 Aug 8.
The continued presentation of patient-detected breast cancer (BC) and associated characteristics over time is understudied.
In a large institutional cohort of first primary stage 0-IV patients with BC in 1990-2019 (n = 15,827), diagnostic method (patient-detected [PtDBC] [n = 5844]; mammography-detected [MamDBC] [nondiagnostic] [n = 9248]; and physician-detected [PhysDBC] [n = 736]) and patient and tumor characteristics including age, race, TNM stage, and hormone-receptor status were reviewed. Pearson χ tests for bivariate comparisons and logistic regression for patient detection-associated factors were used.
In a cohort from 1990 to 2019, the proportion aged 50-74 years (55%-63%; p < .001) and non-White race (9%-37%; p < .001) increased over time. Percentage PtDBC decreased over time but case numbers increased (1990-1999: 44% [n = 1399]; 2010-2019: 34% [n = 2349]; p < .001). Excluding stage 0, PtDBC declined from 47% to 41% over time (p < .001). In 2010-2019, 21% of cases were stage 0, 91% of which were mammography detected (n = 1439). Seventy percent of patient-detected cases were stage II-IV (stage II, 44%; stage III, 20%; stage IV, 6%; p < .001). In adjusted logistic regression, the odds of PtDBC decreased over time (2000-2009: odds ratio [OR], .65 [95% CI, .58-.72]; 2010-2019: OR, .54 [95% CI, .49-.60]), with age <40 years OR, 15.81, and Black and non-White other at 50% increased risk.
The relative proportion of PtDBC decreased to a constant 34%-40% of total cases after 1990-1999. PtDBC case numbers increased in subsequent years (2000-2019), and were consistently higher stage. Interval cancers, mammography-screening uptake, breast health awareness of age groups outside screening guidelines, and underserved socioeconomic groups may be related to the continued significant PtDBC incidence.
After decades of mammography-screening availability, symptomatic patient-detected breast cancer declined over time from 44% to a persistent rate of 34% in our institutional cohort. The persistence of patient-detected breast cancer over time presents a difficult situation for patients and care givers without clear diagnosis pathways for younger and older women outside recommended screening guidelines, who often present with higher stage and more lethal characteristics. More timely diagnosis and treatment including breast health awareness, prompt presentation of breast problems, outreach to younger age and minority groups, and provision of specialized training and care delivery for symptomatic patient-detected breast cancer are needed.
患者发现的乳腺癌（BC）及其相关特征随时间持续呈现的情况研究较少。
在一个包含 1990 年至 2019 年期间首次确诊为 0-IV 期乳腺癌的 15827 例患者的大型机构队列中，研究了诊断方法（患者发现[PtDBC][n=5844]；乳腺 X 线摄影发现[MamDBC][无诊断价值][n=9248]；和医生发现[PhysDBC][n=736]）以及患者和肿瘤特征，包括年龄、种族、TNM 分期和激素受体状态。使用 Pearson χ 检验进行双变量比较，使用 logistic 回归进行与患者检测相关的因素分析。
在 1990 年至 2019 年的队列中，年龄在 50-74 岁的比例（55%-63%；p<0.001）和非白种人种族（9%-37%；p<0.001）随时间推移而增加。PtDBC 的比例随时间下降，但病例数增加（1990-1999 年：44%[n=1399]；2010-2019 年：34%[n=2349]；p<0.001）。排除 0 期后，PtDBC 随时间从 47%降至 41%（p<0.001）。2010-2019 年，21%的病例为 0 期，其中 91%为乳腺 X 线摄影发现（n=1439）。70%的患者发现的病例为 II-IV 期（II 期，44%；III 期，20%；IV 期，6%；p<0.001）。在调整后的 logistic 回归中，PtDBC 的可能性随时间降低（2000-2009 年：比值比[OR]，0.65[95%置信区间，0.58-0.72]；2010-2019 年：OR，0.54[95%置信区间，0.49-0.60]），年龄<40 岁的 OR 为 15.81，黑人和非白种人其他种族的 OR 为 1.50。
1990-1999 年后，PtDBC 的相对比例降至总病例的 34%-40%的稳定水平。随后几年（2000-2019 年）PtDBC 病例数增加，且一直处于较高分期。间期癌、乳腺 X 线摄影筛查接受度、年龄组的乳腺健康意识以及服务不足的社会经济群体可能与持续显著的 PtDBC 发病率有关。
