Warwick Screening, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Screening Quality Assurance Service, NHS England, Birmingham, UK.
BMJ. 2024 Feb 1;384:e077039. doi: 10.1136/bmj-2023-077039.
To explore how the number and type of breast cancers developed after screen detected atypia compare with the anticipated 11.3 cancers detected per 1000 women screened within one three year screening round in the United Kingdom.
Observational analysis of the Sloane atypia prospective cohort in England.
Atypia diagnoses through the English NHS breast screening programme reported to the Sloane cohort study. This cohort is linked to the English Cancer Registry and the Mortality and Birth Information System for information on subsequent breast cancer and mortality.
3238 women diagnosed as having epithelial atypia between 1 April 2003 and 30 June 2018.
Number and type of invasive breast cancers detected at one, three, and six years after atypia diagnosis by atypia type, age, and year of diagnosis.
There was a fourfold increase in detection of atypia after the introduction of digital mammography between 2010 (n=119) and 2015 (n=502). During 19 088 person years of follow-up after atypia diagnosis (until December 2018), 141 women developed breast cancer. Cumulative incidence of cancer per 1000 women with atypia was 0.95 (95% confidence interval 0.28 to 2.69), 14.2 (10.3 to 19.1), and 45.0 (36.3 to 55.1) at one, three, and six years after atypia diagnosis, respectively. Women with atypia detected more recently have lower rates of subsequent cancers detected within three years (6.0 invasive cancers per 1000 women (95% confidence interval 3.1 to 10.9) in 2013-18 24.3 (13.7 to 40.1) in 2003-07, and 24.6 (14.9 to 38.3) in 2008-12). Grade, size, and nodal involvement of subsequent invasive cancers were similar to those of cancers detected in the general screening population, with equal numbers of ipsilateral and contralateral cancers.
Many atypia could represent risk factors rather than precursors of invasive cancer requiring surgery in the short term. Women with atypia detected more recently have lower rates of subsequent cancers detected, which might be associated with changes to mammography and biopsy techniques identifying forms of atypia that are more likely to represent overdiagnosis. Annual mammography in the short term after atypia diagnosis might not be beneficial. More evidence is needed about longer term risks.
探讨通过筛查检测到的非典型性乳腺癌的数量和类型与英国每 1000 名接受三年一轮筛查的女性预期发现的 11.3 例癌症相比有何不同。
对英国斯隆非典型性前瞻性队列的观察性分析。
通过英格兰国民保健制度乳腺筛查计划诊断为非典型性，并报告给斯隆队列研究。该队列与英国癌症登记处和死亡率及出生信息系统相链接，以获取随后乳腺癌和死亡率的信息。
2003 年 4 月 1 日至 2018 年 6 月 30 日期间诊断为上皮非典型性的 3238 名女性。
根据非典型性类型、年龄和诊断年份，在非典型性诊断后 1 年、3 年和 6 年时检测到的浸润性乳腺癌的数量和类型。
在 2010 年（n=119）和 2015 年（n=502）数字乳腺摄影引入后，非典型性的检出率增加了四倍。在非典型性诊断后 19088 人年的随访期间（截至 2018 年 12 月），141 名女性患上了乳腺癌。每 1000 名患有非典型性的女性癌症累积发病率分别为 0.95（95%置信区间 0.28 至 2.69）、14.2（10.3 至 19.1）和 45.0（36.3 至 55.1），分别为诊断后 1 年、3 年和 6 年。最近检出的非典型性患者在 3 年内检出后续癌症的比例较低（2013-18 年每 1000 名女性 6.0 例浸润性癌症（95%置信区间 3.1 至 10.9），2003-07 年每 1000 名女性 24.3（13.7 至 40.1），2008-12 年每 1000 名女性 24.6（14.9 至 38.3））。后续浸润性癌症的分级、大小和淋巴结受累情况与一般筛查人群中检出的癌症相似，同侧和对侧癌症的数量相等。
许多非典型性可能代表风险因素，而不是短期内需要手术的浸润性癌症的前兆。最近检出的非典型性患者后续癌症检出率较低，这可能与乳腺摄影和活检技术的变化有关，这些变化可以识别更有可能代表过度诊断的非典型性形式。非典型性诊断后短期内每年进行乳腺 X 线摄影可能没有益处。需要更多关于长期风险的证据。
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