Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
Acta Oncol. 2024 Jul 5;63:552-556. doi: 10.2340/1651-226X.2024.40200.
We have recently demonstrated that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected. The objective of the study was to analyse differences in breast cancer treatment between screen-detected and non-screen-detected cases by age at diagnosis, with and without adjustment for tumour (T) and nodal (N) status, within a nationwide, population-based mammography screening programme utilising register data.
Data spanning 2008-2017 were collected from the National Quality Register for Breast Cancer. Multivariable logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for treatment disparities between screen-detected and non-screen-detected breast cancer.
Among 46,481 women diagnosed with invasive breast cancer aged 40-74 and invited for mammography screening, significant differences in treatment were observed. Screen-detected cases showed higher likelihoods of partial mastectomy compared to mastectomy, endocrine therapy, and radiotherapy, whereas chemotherapy and antibody therapy were less likely compared to non-screen-detected cases. However, when adjusting for surgery type, screen-detected cases showed lower likelihoods of radiotherapy. Age at diagnosis significantly influenced treatment odds ratios, with interactions observed for all treatments except radiotherapy adjusted for surgery. Differences increased with age, except for endocrine therapy. Radiotherapy adjusted for surgery type showed no age-related interaction. Adjusting for T and N did not alter these patterns.
In general, screen-detected cases received less aggressive treatment, such as mastectomy, chemotherapy, and antibody therapy, compared to non-screen-detected cases. Disparities increased with age, except for endocrine therapy and radiotherapy adjusted for surgery. Differences persisted after adjusting for T and N, suggesting that these factors cannot solely explain the results.
我们最近发现，筛查检出的浸润性乳腺癌比非筛查检出的乳腺癌具有更有利的肿瘤特征。本研究的目的是在一个利用登记数据的全国性基于人群的乳房 X 线筛查计划中，按诊断时的年龄，分析有和无肿瘤（T）和淋巴结（N）状态调整的情况下，筛查检出和非筛查检出的乳腺癌之间的治疗差异。
数据来自国家乳腺癌质量登记处，跨度为 2008 年至 2017 年。多变量逻辑回归分析用于估计筛检检出和非筛检检出乳腺癌之间治疗差异的优势比和 95%置信区间。
在 46481 名 40-74 岁被诊断为浸润性乳腺癌且被邀请接受乳房 X 线筛查的女性中，观察到治疗存在显著差异。与乳房切除术相比，筛检检出的病例更有可能选择部分乳房切除术，而内分泌治疗和放疗的可能性较低，而与非筛检检出的病例相比，化疗和抗体治疗的可能性较低。然而，在调整手术类型后，筛检检出的病例接受放疗的可能性较低。诊断时的年龄显著影响治疗的优势比，除了调整手术的放射治疗外，所有治疗都观察到交互作用。差异随着年龄的增长而增加，但内分泌治疗除外。调整手术类型后的放射治疗没有显示出与年龄相关的交互作用。调整 T 和 N 并不能改变这些模式。
一般来说，与非筛检检出的病例相比，筛检检出的病例接受的治疗侵袭性较小，如乳房切除术、化疗和抗体治疗。除了内分泌治疗和调整手术的放射治疗外，差异随着年龄的增长而增加。在调整 T 和 N 后，差异仍然存在，这表明这些因素不能完全解释结果。
