Stockton D, Davies T, Day N, McCann J
Department of Community Medicine, Institute of Public Health, University of Cambridge.
BMJ. 1997 Feb 15;314(7079):472-5. doi: 10.1136/bmj.314.7079.472.
To investigate the recent fall in mortality from breast cancer in England and Wales, and to determine the relative contributions of improvements in treatment and earlier detection of tumours.
Retrospective study of all women with breast cancer registered by the East Anglian cancer registry and diagnosed between 1982 and 1989.
3965 patients diagnosed 1982-5 compared with 4665 patients diagnosed 1986-9, in three age groups 0-49, 50-64, > or = 65 years, with information on stage at diagnosis and survival.
Three year relative survival rates by time period, age group, and stage; relative hazard ratios for each time period and age group derived from Cox's proportional hazards model, adjusted for single year of age and stage.
Survival improved in the later time period, although there was little stage specific improvement. The proportion of early stage tumours increased especially in the 50-64 year age group, and adjustment for stage accounted for over half of the improvement in survival in women aged under 65 years.
Over half of the drop in mortality in women aged under 65 years seems to be attributable to earlier detection of tumours, which has been observed since the mid-1980s. This could have resulted from an increase in breast awareness predating the start of the breast screening programme.
调查英格兰和威尔士乳腺癌死亡率近期的下降情况，并确定治疗改善和肿瘤早期发现各自的相对贡献。
对东安格利亚癌症登记处登记的、在1982年至1989年期间确诊的所有乳腺癌女性患者进行回顾性研究。
3965例于1982 - 1985年确诊的患者与4665例于1986 - 1989年确诊的患者，分为0 - 49岁、50 - 64岁、≥65岁三个年龄组，记录了诊断时的分期和生存情况。
按时间段、年龄组和分期划分的三年相对生存率；根据Cox比例风险模型得出的各时间段和年龄组的相对风险比，并根据年龄和分期进行单年调整。
在后期生存情况有所改善，尽管各分期的改善不太明显。早期肿瘤的比例有所增加，尤其是在50 - 64岁年龄组，对分期进行调整后，65岁以下女性生存率改善的一半以上可归因于此。
65岁以下女性死亡率下降的一半以上似乎归因于肿瘤的早期发现，这一现象自20世纪80年代中期以来就已出现。这可能是由于在乳腺筛查计划开始之前乳腺保健意识的提高。
