评估金砖国家及其他国家乳腺癌筛查项目在死亡率、病例病死率和伤残调整寿命年方面的差异。

BACKGROUND: Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective. METHODS: In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries. RESULTS: Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented. CONCLUSIONS: The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.

背景：过去四十年的众多研究表明，乳腺癌筛查（BCS）可显著降低乳腺癌（BC）死亡率。然而，在金砖国家加六国（BRICS-plus），BCS 与 BC 病死率和失能调整生命年（DALY）率之间的关联尚不清楚。本研究从国家和经济角度探讨了不同 BCS 方法与年龄标准化死亡率、病例死亡率和 DALY 率之间的关联，以及与其他生物学和社会人口学风险变量之间的关联，涵盖了 BRICS-plus 国家。

方法：在这项应用混合效应多水平回归模型的生态学研究中，通过将 2019 年全球疾病负担研究中女性年龄标准化 BC 死亡率、发病率和 DALY 率的数据与关于国家/地区 BCS 可及性（无此类项目或仅有试点项目）和 BCS 类型（仅自我乳房检查（SBE）和/或临床乳房检查（CBE）[SBE/CBE]与 SBE/CBE 加乳房 X 线摄影筛查可用性[MM 和/或 SBE/CBE]与 SBE/CBE 加数字乳房 X 线摄影和/或超声（US）[DMM/US 和/或先前的测试]的信息相结合，对 BRICS-plus 国家的数据进行了分析。

结果：与 BRICS-plus 中的自我/临床乳房检查（SBE/CBE）相比，更复杂的 BCS 方案可用性是死亡率降低的最显著预测因素[MM 和/或 SBE/CBE：-2.64，p<0.001；DMM/US 和/或先前的测试：-1.40，p<0.001]。在 BRICS-plus 中，CVD 存在、高 BMI、二手烟和主动吸烟均导致 BC 死亡率和 DALY 率升高。在 BRICS-plus 中，高收入和中等收入地区的年龄标准化 BC 死亡率、病例死亡率和 DALY 率低于低收入地区，因为在全国范围内实施了乳腺癌筛查计划。

结论：在 BRICS-plus 国家，乳腺癌筛查（数字或传统）和 BCS 的可用性与乳腺癌负担相关，存在区域性差异。鉴于先前因果研究的高质量证据，这些发现进一步支持了在国家层面进行乳腺 X 线摄影筛查在乳腺癌预防中的作用。干预 BCS 相关风险因素可能会进一步降低与 BC 相关的疾病负担。