乳腺癌发病率上升但死亡率下降。瑞典马尔默的趋势，1961 - 1992年。

Increasing incidence of and declining mortality from breast carcinoma. Trends in Malmö, Sweden, 1961-1992.

作者信息

Garne J P, Aspegren K, Balldin G, Ranstam J

机构信息

Department of Surgery, Malmö University Hospital, Sweden.

出版信息

Cancer. 1997 Jan 1;79(1):69-74.

PMID:8988728

Abstract

BACKGROUND

The incidence of breast carcinoma is increasing in most populations, whereas mortality caused by this disease is fairly constant. The authors analyzed the incidence of and mortality from invasive breast carcinoma in a population with access to good medical care, into which mammographic screening was introduced in 1976 and adjuvant therapy in 1978.

METHODS

In a consecutive series of patients with invasive breast carcinoma from Malmö, 1961-1991, changes in age-adjusted incidence were analyzed and compared with incidence of the disease in the rest of Sweden. Age-adjusted breast carcinoma mortality was studied for the period 1964-1992.

RESULTS

The introduction of mammographic screening was associated with an increase in breast carcinoma incidence. This was restricted to the age group that was eligible for screening (age 45-69 years) and to Stage I disease. Between 1977 and 1992, age-adjusted breast carcinoma mortality decreased in Malmö by 43% (95% CI, 26-56%) as compared with 12% (95% CI, 8-16%) in the rest of Sweden. The decrease was statistically significant in both populations and significantly greater in Malmö than in the rest of Sweden (P < 0.001). In Malmö the decrease was seen in two age groups, age 45-69 years and age 70 years and older. In the rest of Sweden the decrease was seen only among women age 70 years and older. In the rest of Sweden the decrease was seen only among women age 70 years and older. There were no changes in incidence or mortality among women younger than 45 years in either population.

CONCLUSIONS

Breast carcinoma incidence was strongly related to diagnostic activity, especially mammographic screening. The decrease in mortality occurred in temporal relation to the introduction of screening and adjuvant therapy, making a causal relation likely. The difference in results between Malmö and the rest of Sweden indicates an important role for screening in mortality reduction.

摘要

背景

在大多数人群中，乳腺癌的发病率呈上升趋势，而由该疾病导致的死亡率却相当稳定。作者分析了在一个能获得优质医疗服务的人群中浸润性乳腺癌的发病率和死亡率，该人群于1976年引入了乳腺钼靶筛查，并于1978年引入了辅助治疗。

方法

在1961 - 1991年来自马尔默的一系列连续性浸润性乳腺癌患者中，分析年龄调整后的发病率变化，并与瑞典其他地区的疾病发病率进行比较。研究了1964 - 1992年期间年龄调整后的乳腺癌死亡率。

结果

乳腺钼靶筛查的引入与乳腺癌发病率的增加相关。这仅限于符合筛查条件的年龄组（45 - 69岁）和I期疾病。1977年至1992年期间，马尔默年龄调整后的乳腺癌死亡率下降了43%（95%可信区间，26 - 56%），而瑞典其他地区下降了12%（95%可信区间，8 - 16%）。两个地区的下降在统计学上均有显著意义，且马尔默的下降幅度明显大于瑞典其他地区（P < 0.001）。在马尔默，45 - 69岁和70岁及以上两个年龄组出现了下降。在瑞典其他地区，仅70岁及以上的女性出现了下降。在这两个人群中，45岁以下女性的发病率和死亡率均无变化。