Shapiro S, Venet W, Strax P, Venet L, Roeser R
J Natl Cancer Inst. 1982 Aug;69(2):349-55.
Results from the randomized trial conducted by the Health Insurance Plan (HIP) to determine the efficacy of breast cancer screening with mammography and palpation are reported for longer periods than previously available. By the end of 10 years after entry, the study group's mortality due to breast cancer was about 30% below the control group's. Arithmetic gains due to screening were maintained through year 14; relative gains declined. With increases in the period of follow-up, cumulative survival rates among cases detected by mammography alone (palpation negative during screening), decreased more rapidly than rates among other subgroups, but survival rates for mammography cases remained relatively high. Study women aged 40-49 years at entry began to show lower breast cancer mortality than those in the control group as duration of follow-up increased. Reservations are advanced about the acceptance of this finding as evidence of the efficacy of screening under age 50 under the conditions of the HIP study. The reservations are based on the observation that the decrease of mortality among the study group aged 45-49 at entry is concentrated entirely among cases diagnosed after they reached 50 years of age.
健康保险计划（HIP）进行的一项随机试验旨在确定乳房X光检查和触诊进行乳腺癌筛查的效果，该试验结果的报告时间比以前更长。入组10年后，研究组因乳腺癌导致的死亡率比对照组低约30%。筛查带来的算术收益在第14年一直保持；相对收益有所下降。随着随访时间的增加，仅通过乳房X光检查发现的病例（筛查时触诊阴性）的累积生存率下降速度比其他亚组更快，但乳房X光检查病例的生存率仍然相对较高。入组时年龄在40 - 49岁的研究女性随着随访时间的增加，乳腺癌死亡率开始低于对照组。对于在HIP研究条件下接受这一发现作为50岁以下筛查效果的证据存在一些保留意见。这些保留意见基于这样的观察结果：入组时年龄在45 - 49岁的研究组中死亡率的下降完全集中在50岁以后诊断出的病例中。
