Taplin S H, Mandelson M T, Anderman C, White E, Thompson R S, Timlin D, Wagner E H
Department of Preventive Care, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98101-1448, USA.
Cancer Epidemiol Biomarkers Prev. 1997 Aug;6(8):625-31.
The purpose of this study was to assess mammography diffusion in a population offered an organized breast cancer screening program, using intervals of 1-3 years, and to evaluate its effect on the late-stage cancer (tumors > or = 3 cm2) rates compared to rates in the surrounding community. We measured "ever-use" of mammography (1986-1992) among women enrollees of a consumer-controlled health care organization (n > or = 60,000/year; ages > or = 40), Group Health Cooperative of Puget Sound (GHC). Among these same women and the surrounding community (n = > or = 745,000/year), we measured late-stage cancer rates. Using unconditional logistic regression, we compared annual rates of ever-use among GHC women ages 40-49 and > or = 50 (1986-1992) and late-stage breast cancer (1983/84-1991/92) among all women. Among all GHC women ages 40 to 49, and 50 years of age and older, 67.4 and 82.8%, respectively, ever-used mammography by 1992. By 1992, approximately one-third of the mammograms among GHC women occurred in each of the three previous years. The rate of late-stage tumors declined significantly in the GHC and non-GHC populations among women 50 years of age and older (P < 0.001) but not among women ages 40 to 49. In conclusion, implementing a system of automated reminders was not sufficient to maximize mammography use in a population. Reductions in late-stage disease occurred among women ages > or = 50, even when regular" was not synonymous with "annual."
本研究的目的是评估在一个提供有组织的乳腺癌筛查项目的人群中，使用1至3年的间隔期进行乳房X线摄影的普及情况，并与周边社区的比率相比，评估其对晚期癌症（肿瘤面积≥3平方厘米）发生率的影响。我们测量了普吉特海湾地区团体健康合作社（GHC）这一由消费者控制的医疗保健组织中女性参保者（每年n≥60,000；年龄≥40岁）在1986年至1992年间乳房X线摄影的“曾经使用情况”。在这些相同的女性以及周边社区（每年n≥745,000）中，我们测量了晚期癌症的发生率。我们使用无条件逻辑回归，比较了GHC中40至49岁以及≥50岁女性（1986年至1992年）的年度曾经使用率，以及所有女性中晚期乳腺癌（1983/84年至1991/92年）的发生率。在所有40至49岁以及50岁及以上的GHC女性中，到1992年分别有67.4%和82.8%的人曾经使用过乳房X线摄影。到1992年，GHC女性中的乳房X线摄影检查约有三分之一发生在之前三年中的每一年。在50岁及以上的女性中，GHC人群和非GHC人群中晚期肿瘤的发生率均显著下降（P<0.001），但在40至49岁的女性中并非如此。总之，实施自动提醒系统不足以在人群中最大限度地提高乳房X线摄影的使用率。在年龄≥50岁的女性中，即使“定期”并不等同于“每年”，晚期疾病的发生率也有所下降。
