Miller A B
Department of Preventive Medicine and Biostatistics, University of Toronto, Canada.
Cancer Detect Prev. 1994;18(4):305-11.
Some organizations in the U.S. recommend mammography screening at 1- to 2-year intervals for those aged 40 to 49 and annually from the age of 50. In Canada and Europe, screening mammography is not recommended for women aged 40 to 49, and mammography every 2 to 3 years for women aged 50 to 69. The screening studies in Europe show no evidence of effectiveness of mammography screening in women aged 40 to 49 in the first 8 to 10 years after initiation of screening. Although at 12 years the recent Swedish overview analysis shows a 13% reduction, this is nonsignificant and the confidence intervals are wide. In the National Breast Screening Study (NBSS) in Canada, annual two-view mammography and physical examinations by carefully trained health professionals were given. In women aged 40 to 49 the ratio of proportions of deaths was 1.36 (95% CI 0.84, 2.21). For women aged 50 to 59, the NBSS evaluated the contribution of mammography over and above physical examination. In spite of detecting many more cancers, mammography did not result in a reduction in breast cancer mortality at 7 years (OR 0.97; 95% CI 0.62, 1.52). Although these results suggest the benefit from screening may be less than assumed, for women over 50, biennial screening to age 74 is probably appropriate in population programs, although careful monitoring will be necessary to ensure that the anticipated effect is achieved.
美国的一些组织建议，40至49岁的人群每1至2年进行一次乳腺钼靶筛查，50岁起每年进行一次。在加拿大和欧洲，不建议40至49岁的女性进行乳腺钼靶筛查，50至69岁的女性每2至3年进行一次。欧洲的筛查研究表明，在开始筛查后的最初8至10年里，没有证据显示乳腺钼靶筛查对40至49岁的女性有效。尽管最近瑞典的综述分析显示，在12年时乳腺癌死亡率降低了13%，但这一结果不显著，且置信区间较宽。在加拿大的全国乳腺筛查研究（NBSS）中，由训练有素的健康专业人员进行每年两次的乳腺钼靶检查和体格检查。40至49岁女性的死亡比例之比为1.36（95%置信区间为0.84, 2.21）。对于50至59岁的女性，NBSS评估了乳腺钼靶检查相对于体格检查的贡献。尽管检测出了更多的癌症，但乳腺钼靶检查在7年时并未降低乳腺癌死亡率（比值比0.97；95%置信区间为0.62, 1.52）。尽管这些结果表明筛查的益处可能比预期的要小，但对于50岁以上的女性，在人群项目中每两年筛查至74岁可能是合适的，不过需要仔细监测以确保达到预期效果。
