Beemsterboer P M, de Koning H J, Warmerdam P G, Boer R, Swart E, Dierks M L, Robra B P
Department of Public Health, Erasmus Universiteit, Rotterdam, The Netherlands.
Int J Cancer. 1994 Sep 1;58(5):623-8. doi: 10.1002/ijc.2910580502.
Although breast-cancer screening programmes are now being introduced it is still debated whether this is an appropriate policy for all European countries. Taking into account empirical data from 2 regional pilot screening projects, this study has evaluated the effects and costs of a nationwide breast-cancer screening programme in Germany. Special attention was paid to the decentralized German health-care system and to the influence of attendance, interval and age group. The recent results of the analysis of the Swedish randomized screening trials were used to estimate the improvement in prognosis after early detection of breast cancer. Our analysis shows that a programme providing for the screening of women aged 50-69 at 2-year intervals might be expected to result in a decrease in mortality from breast cancer estimated at 11% for the total German population, representing 2,100 deaths from breast cancer prevented each year. The cost per life-year gained was assessed at between DM 18,800 and DM 25,300 for this scenario; 2 to 3 times less favourable than in the UK and The Netherlands. The sensitivity of mammography was estimated to be 12% lower than in The Netherlands and the attendance rate was calculated at 47% on average. A greater effort to ensure the quality of the screening programme and to improve the invitation system might finally lead to much better results. The mortality reduction might be as much as 18% if the attendance and the sensitivity of the screening could be improved to the Dutch level.
尽管目前正在推行乳腺癌筛查项目，但对于这是否适用于所有欧洲国家仍存在争议。考虑到两个地区试点筛查项目的实证数据，本研究评估了德国全国性乳腺癌筛查项目的效果和成本。特别关注了德国分散的医疗保健系统以及参与率、筛查间隔和年龄组的影响。利用瑞典随机筛查试验的最新分析结果来估计乳腺癌早期发现后预后的改善情况。我们的分析表明，一个为50至69岁女性每两年进行一次筛查的项目，预计可能会使德国总人口的乳腺癌死亡率降低11%，即每年可预防2100例乳腺癌死亡。在这种情况下，每获得一个生命年的成本估计在18,800德国马克至25,300德国马克之间；比英国和荷兰的情况差2至3倍。乳房X线摄影的敏感度估计比荷兰低12%，平均参与率计算为47%。加大力度确保筛查项目的质量并改进邀请系统，最终可能会带来更好的结果。如果参与率和筛查敏感度能够提高到荷兰的水平，死亡率降低幅度可能高达18%。
