Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakobstr. 21, 9000, St. Gallen, Switzerland.
Cancer League of Eastern Switzerland, St. Gallen, Switzerland.
Breast Cancer Res. 2024 May 27;26(1):84. doi: 10.1186/s13058-024-01841-6.
We compared the survival rates of women with breast cancer (BC) detected within versus outside the mammography screening program (MSP) "donna".
We merged data from the MSP with the data from corresponding cancer registries to categorize BC cases as within MSP (screen-detected and interval carcinomas) and outside the MSP. We analyzed the tumor stage distribution, tumor characteristics and the survival of the women. We further estimated hazard ratios using Cox-regressions to account for different characteristics between groups and corrected the survival rates for lead-time bias.
We identified 1057 invasive (ICD-10: C50) and in-situ (D05) BC cases within the MSP and 1501 outside the MSP between 2010 and 2019 in the Swiss cantons of St. Gallen and Grisons. BC within the MSP had a higher share of stage I carcinoma (46.5% vs. 33.0%; p < 0.01), a smaller (mean) tumor size (19.1 mm vs. 24.9 mm, p < 0.01), and fewer recurrences and metastases in the follow-up period (6.7% vs. 15.6%, p < 0.01). The 10-year survival rates were 91.4% for women within and 72.1% for women outside the MSP (p < 0.05). Survival difference persisted but decreased when women within the same tumor stage were compared. Lead-time corrected hazard ratios for the MSP accounted for age, tumor size and Ki-67 proliferation index were 0.550 (95% CI 0.389, 0.778; p < 0.01) for overall survival and 0.469 (95% CI 0.294, 0.749; p < 0.01) for BC related survival.
Women participating in the "donna" MSP had a significantly higher overall and BC related survival rate than women outside the program. Detection of BC at an earlier tumor stage only partially explains the observed differences.
我们比较了在乳腺摄影筛查计划（MSP）“donna”内和外发现的乳腺癌（BC）患者的生存率。
我们将 MSP 中的数据与相应的癌症登记处的数据合并，将 BC 病例分为 MSP 内（筛查发现和间隔癌）和 MSP 外。我们分析了肿瘤分期分布、肿瘤特征和患者的生存情况。我们进一步使用 Cox 回归估计风险比，以考虑组间不同的特征，并校正生存时间偏倚。
我们在 2010 年至 2019 年间在瑞士圣加仑和格劳宾登州的“donna”MSP 内识别了 1057 例浸润性（ICD-10：C50）和原位（D05）BC 病例，在 MSP 外识别了 1501 例。MSP 内的 BC 具有更高的 I 期癌比例（46.5%比 33.0%；p<0.01）、更小的（平均）肿瘤大小（19.1 毫米比 24.9 毫米，p<0.01），以及在随访期间更少的复发和转移（6.7%比 15.6%，p<0.01）。MSP 内的 10 年生存率为 91.4%，MSP 外的为 72.1%（p<0.05）。当比较同一肿瘤分期的女性时，生存差异仍然存在，但有所减小。校正 MSP 的生存时间偏倚的危险比考虑了年龄、肿瘤大小和 Ki-67 增殖指数，整体生存率为 0.550（95%CI 0.389，0.778；p<0.01），BC 相关生存率为 0.469（95%CI 0.294，0.749；p<0.01）。
参加“donna”MSP 的女性总体生存率和 BC 相关生存率明显高于计划外的女性。BC 在早期肿瘤阶段的检出仅部分解释了观察到的差异。
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