Department of Radiology, New York University Langone Health, New York, USA.
Department of Radiology, State University of New York at Stony Brook, Renaissance School of Medicine, Stony Brook, NY, USA.
Breast Cancer Res Treat. 2024 Feb;203(3):599-612. doi: 10.1007/s10549-023-07124-6. Epub 2023 Oct 28.
There are insufficient large-scale studies comparing the performance of screening mammography in women of different races. This study aims to compare the screening performance metrics across racial and age groups in the National Mammography Database (NMD).
All screening mammograms performed between January 1, 2008, and December 31, 2021, in women aged 30-100 years from 746 mammography facilities in 46 U.S. states in the NMD were included. Patients were stratified by 10-year age intervals and 5 racial groups (African American, American Indian, Asian, White, unknown). Incidence of risk factors (breast density, personal history, family history of breast cancer, age), and time since prior exams were compared. Five screening mammography metrics were calculated: recall rate (RR), cancer detection rate (CDR), positive predictive values for recalls (PPV), biopsy recommended (PPV) and biopsy performed (PPV).
29,479,655 screening mammograms performed in 13,181,241 women between January 1, 2008, and December 31, 2021, from the NMD were analyzed. The overall mean performance metrics were RR 10.00% (95% CI 9.99-10.02), CDR 4.18/1000 (4.16-4.21), PPV 4.18% (4.16-4.20), PPV 25.84% (25.72-25.97), PPV 25.78% (25.66-25.91). With advancing age, RR significantly decreases, while CDR, PPV, PPV, and PPV significantly increase. Incidence of personal/family history of breast cancer, breast density, age, prior mammogram availability, and time since prior mammogram were mostly similar across all races. Compared to White women, African American women had significantly higher RR, but lower CDR, PPV, PPV and PPV.
Benefits of screening mammography increase with age, including for women age > 70 and across all races. Screening mammography is effective; with lower RR and higher CDR, PPV, and PPV with advancing age. African American women have poorer outcomes from screening mammography (higher RR and lower CDR), compared to White and all women in the NMD. Racial disparity can be partly explained by higher rate of African American women lost to follow up.
目前缺乏大规模研究比较不同种族女性的筛查乳房 X 光检查表现。本研究旨在比较国家乳房 X 光检查数据库（NMD）中不同种族和年龄组的筛查表现指标。
纳入 2008 年 1 月 1 日至 2021 年 12 月 31 日期间在 NMD 中 46 个美国州的 746 个乳房 X 光检查设施中年龄在 30-100 岁的女性进行的所有筛查乳房 X 光检查。患者按 10 年年龄间隔和 5 个种族（非裔美国人、美洲原住民、亚洲人、白人、未知）分层。比较了发病风险因素（乳房密度、个人病史、乳腺癌家族史、年龄）和上次检查后的时间。计算了 5 项筛查乳房 X 光检查指标：召回率（RR）、癌症检出率（CDR）、召回的阳性预测值（PPV）、建议活检（PPV）和实际活检（PPV）。
分析了 2008 年 1 月 1 日至 2021 年 12 月 31 日期间 NMD 中 13181241 名女性进行的 29479655 次筛查乳房 X 光检查。总体平均表现指标为 RR 10.00%（95%CI 9.99-10.02）、CDR 4.18/1000（4.16-4.21）、PPV 4.18%（4.16-4.20）、PPV 25.84%（25.72-25.97）、PPV 25.78%（25.66-25.91）。随着年龄的增长，RR 显著下降，而 CDR、PPV、PPV 和 PPV 显著增加。个人/家族乳腺癌史、乳房密度、年龄、上次乳房 X 光检查的可用性和上次乳房 X 光检查后的时间在所有种族中大多相似。与白人女性相比，非裔美国女性的 RR 显著更高，但 CDR、PPV、PPV 和 PPV 显著更低。
筛查乳房 X 光检查的益处随着年龄的增长而增加，包括年龄>70 岁的女性和所有种族。筛查乳房 X 光检查是有效的；随着年龄的增长，RR 降低，CDR、PPV 和 PPV 升高。与白人女性和 NMD 中的所有女性相比，非裔美国女性的筛查乳房 X 光检查结果较差（RR 较高，CDR 较低）。种族差异部分可以通过非裔美国女性随访丢失率较高来解释。
