Choi W S, Parker B A, Pierce J P, Greenberg E R
Cancer Prevention and Control Program, University of California, San Diego, La Jolla 92093-0901, USA.
Cancer Epidemiol Biomarkers Prev. 1996 Apr;5(4):317-20.
Greater use of mammography in the United States in recent years has increased the detection of early neoplasms of the breast, including carcinoma in situ. However, the occurrence and treatment of diagnosed carcinoma in situ of the breast has not been fully described. Our goal was to examine temporal, geographic, and demographic patterns in the incidence and treatment of in situ breast cancer. The study included data from all women with in situ breast cancer that had been detected in the nine Surveillance, Epidemiology, and End Results areas of the United States from 1975 through 1990 (Surveillance Program, Cancer Statistics Branch, Bethesda, MD: National Cancer Institute, November, 1993). We calculated age-adjusted incidence rates (1970 United States standard) using data on histology and treatment from the Surveillance, Epidemiology, and End Results data tape. We assessed predictors of treatment by mastectomy using multiple logistic regression. From 1975-1979 to 1986-1990, the age-adjusted incidence rate of in situ breast cancer increased from 4.7 to 16.9/100,000 women. The increase occurred in all age groups and among both white and black women. However, there was nearly a 2-fold difference in incidence rates across geographic areas in 1986-1990, ranging from < 12/100,000 in Iowa and New Mexico to > 20/100,000 in San Francisco and Seattle. Geographic variability in treatment was also evident, with mastectomy, rather than breast-conserving therapy, performed on 46% of the women with in situ breast cancer in San Francisco and on 66% of those in Iowa. The incidence of diagnosed in situ breast cancer increased markedly during the 1980s, and there was substantial geographic variability in the rates of detection of these tumors and in the type of therapy received. Although mastectomy became a less common treatment over time, it was still performed on a high proportion of women with in situ breast cancer during the latter part of the decade.
近年来，美国乳腺钼靶检查的使用增多，这提高了包括原位癌在内的早期乳腺肿瘤的检出率。然而，已确诊的乳腺原位癌的发生情况和治疗情况尚未得到充分描述。我们的目标是研究乳腺原位癌发病率和治疗的时间、地理和人口统计学模式。该研究纳入了1975年至1990年在美国九个监测、流行病学和最终结果地区检测到的所有乳腺原位癌女性的数据（监测项目，癌症统计处，贝塞斯达，马里兰州：国家癌症研究所，1993年11月）。我们使用来自监测、流行病学和最终结果数据磁带的组织学和治疗数据计算年龄调整发病率（1970年美国标准）。我们使用多元逻辑回归评估乳房切除术治疗的预测因素。从1975 - 1979年到1986 - 1990年，乳腺原位癌的年龄调整发病率从4.7/10万女性增加到16.9/10万女性。各年龄组以及白人和黑人女性中均出现了这种增长。然而，1986 - 1990年不同地理区域的发病率存在近2倍的差异，从爱荷华州和新墨西哥州的<12/10万到旧金山和西雅图的>20/10万。治疗的地理差异也很明显，旧金山46%的乳腺原位癌女性接受了乳房切除术，而非保乳治疗，爱荷华州这一比例为66%。20世纪80年代，已确诊的乳腺原位癌发病率显著上升，这些肿瘤的检出率和接受的治疗类型存在很大的地理差异。尽管随着时间推移乳房切除术不再是一种常见的治疗方法，但在该十年后期，仍有很大比例的乳腺原位癌女性接受了这种手术。
