Kerlikowske K, Grady D, Barclay J, Sickles E A, Ernster V
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
JAMA. 1996 Jul 3;276(1):33-8.
To determine factors that influence the sensitivity of modern first screening mammography.
Cross-sectional.
Nine counties in northern California.
A total of 28 271 women aged 30 years and older referred for first screening mammography to the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to March 1992, of whom 238 were subsequently diagnosed as having breast cancer.
Breast cancer risk profile, 2 standard mammographic views per breast, breast density, and follow-up of abnormal and normal mammography by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry to determine the occurrence of any invasive cancer or ductal carcinoma in situ.
For women aged 50 years and older, the sensitivity of first screening mammography was relatively high and decreased slightly with increasing length of follow-up after mammography: 98.5% for 7 months of follow-up, 93.2% for 13 months, and 85.7% for 25 months. Sensitivity was higher among women aged 50 years and older when breast density was primarily fatty rather than primarily dense (98.4% vs 83.7%; P < .01). For women younger than 50 years, the sensitivity of first screening mammography also decreased with increasing length of follow-up but was significantly lower than for older women: 87.5% for 7 months of follow-up, 83.6% for 13 months, and 71.4% for 25 months. For women younger than 50 years, breast density did not affect the sensitivity of mammography (81.8% for those with primarily fatty breasts vs 85.4% for those with primarily dense breasts) and was lower among those with a family history of breast cancer (68.8%).
The sensitivity of modern mammography is highest among women aged 50 years and older who have primarily fatty breast density. Sensitivity is lowest among women younger than 50 years and particularly low when the time between screenings is about 2 years or when women have a family history of breast cancer, possibly because of rapid tumor growth.
确定影响现代首次乳腺钼靶筛查敏感性的因素。
横断面研究。
加利福尼亚州北部的9个县。
1985年4月至1992年3月期间，共有28271名30岁及以上的女性被转诊至加利福尼亚大学旧金山分校的流动乳腺钼靶筛查项目进行首次乳腺钼靶筛查，其中238名女性随后被诊断患有乳腺癌。
乳腺癌风险概况、每侧乳房2张标准钼靶片、乳房密度，以及通过联系女性的医生并与区域监测、流行病学和最终结果肿瘤登记处建立联系，对异常和正常钼靶检查进行随访，以确定任何浸润性癌症或原位导管癌的发生情况。
对于50岁及以上的女性，首次乳腺钼靶筛查的敏感性相对较高，且随着钼靶检查后随访时间的延长略有下降：随访7个月时为98.5%，13个月时为93.2%，25个月时为85.7%。当乳房密度主要为脂肪型而非致密型时，50岁及以上女性的敏感性更高（98.4%对83.7%；P <.01）。对于50岁以下的女性，首次乳腺钼靶筛查的敏感性也随着随访时间的延长而降低，但显著低于老年女性：随访7个月时为87.5%，13个月时为83.6%，25个月时为71.4%。对于50岁以下的女性，乳房密度不影响钼靶检查的敏感性（主要为脂肪型乳房的女性为81.8%，主要为致密型乳房的女性为85.4%），且有乳腺癌家族史的女性敏感性较低（68.8%）。
现代钼靶检查在50岁及以上、乳房密度主要为脂肪型的女性中敏感性最高。在50岁以下的女性中敏感性最低，尤其是当筛查间隔约为2年或女性有乳腺癌家族史时，可能是由于肿瘤生长迅速。
