Haraldsdottir Alfheidur, Birgisson Helgi, Agustsson Agust I, Tryggvadottir Laufey
Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.
Cancer Screening Coordination Centre, Primary Health Care of the Capital Area, Reykjavik, Iceland.
Acta Oncol. 2025 Aug 14;64:1061-1070. doi: 10.2340/1651-226X.2025.44090.
Organised mammography screening reduces breast cancer mortality by 30-40% in women aged 50-69. Despite limited evidence for women aged 40-49, screening guidelines are trending toward younger ages. Iceland has offered biennial screening to women aged 40-69 since 1987. This study compares screening quality indicators and tumour characteristics between women aged 40-49 and 50-69 from 1990 to 2020. Patient/material and methods: Screening-related data were obtained from the Icelandic Breast Cancer Screening Program, and breast cancer diagnoses and tumour characteristics were sourced from the Icelandic Cancer Registry.
In total, 84,677 women aged 40-69 years attended 455,532 organised screening sessions in Iceland over a 30-year period. Women aged 40-49 years demonstrated higher recall rates (4.9% vs. 3.5%) and lower participation rates (60.7% vs. 61.5%), lower breast cancer detection rates (2.1 vs. 6.0/1,000), and lower episode sensitivity (54.8% vs. 70.5%), compared to those aged 50-69 years. Among screen-detected cases, women aged 40-49 years exhibited a higher proportion of tumours larger than 20 mm (29.7% vs. 21.7%), more lymph node positivity (41.2% vs. 28.2%) and higher human epidermal growth factor receptor 2 (HER2) positivity (18.6% vs. 11.8%), compared to those aged 50-69 years.
The disparity in breast cancer screening performances between the age groups may reflect unmodifiable factors in younger women. The presence of advanced tumour characteristics among women aged 40-49 years who attended screening indicates the importance of early detection for improving prognosis.
有组织的乳腺钼靶筛查可使50 - 69岁女性的乳腺癌死亡率降低30% - 40%。尽管40 - 49岁女性的相关证据有限，但筛查指南正趋向于更低年龄。自1987年以来，冰岛为40 - 69岁女性提供两年一次的筛查。本研究比较了1990年至2020年40 - 49岁和50 - 69岁女性的筛查质量指标及肿瘤特征。患者/材料与方法：筛查相关数据来自冰岛乳腺癌筛查项目，乳腺癌诊断及肿瘤特征数据来自冰岛癌症登记处。
在30年期间，冰岛共有84,677名40 - 69岁女性参加了455,532次有组织的筛查。与50 - 69岁女性相比，40 - 49岁女性的召回率更高（4.9%对3.5%）、参与率更低（60.7%对61.5%）、乳腺癌检出率更低（2.1对6.0/1000）以及筛查敏感性更低（54.8%对70.5%）。在筛查发现的病例中，与50 - 69岁女性相比，40 - 49岁女性肿瘤大于20毫米的比例更高（29.7%对21.7%）、淋巴结阳性比例更高（41.2%对28.2%）以及人表皮生长因子受体2（HER2）阳性比例更高（18.6%对11.8%）。
不同年龄组乳腺癌筛查表现的差异可能反映了年轻女性中不可改变的因素。参加筛查的40 - 49岁女性中存在晚期肿瘤特征，这表明早期检测对于改善预后的重要性。
