Harvey B J, Miller A B, Baines C J, Corey P N
Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Ont.
CMAJ. 1997 Nov 1;157(9):1205-12.
To measure the effect of breast self-examination (BSE) technique and frequency on the risk of death from breast cancer.
Case-control study nested within the Canadian National Breast Screening Study (NBSS).
The Canadian NBSS, a multicentre randomized controlled trial of screening for breast cancer in Canadian women.
The case subjects were 163 women who had died from breast cancer and 57 women with distant metastases. Ten control subjects matched by 5-year age group, screening centre, year of enrolment and random allocation group were randomly selected for each case subject.
Self-reported BSE frequency before enrolment in the NBSS, annual self-reports of BSE frequency during the program and annual objective assessments of BSE technique.
Odds ratios (ORs) associated with BSE practice were estimated by conditional multiple logistic regression modelling, which permitted control of covariates.
Relative to women who, when assessed 2 years before diagnosis, examined their breasts visually, used their finger pads for palpation and examined with their 3 middle fingers, the OR for death from breast cancer or distant metastatic disease for women who omitted 1, 2 or 3 of these components was 2.20 (95% confidence interval [CI] 1.30 to 3.71, p = 0.003). The OR for women who omitted 1 of the 3 components was 1.82 (95% CI 1.00 to 3.29, p = 0.05), for those who omitted 2 of the 3 components, 2.84 (95% CI 1.44 to 5.59, p = 0.003), and for those who omitted all 3 components, 2.95 (95% CI 1.19 to 7.30, p = 0.02). The results remained unchanged after adjustment for potential confounders.
The results, obtained with the use of prospectively collected data, suggest that the performance of specific BSE components may reduce the risk of death from breast cancer.
评估乳房自我检查(BSE)技术及频率对乳腺癌死亡风险的影响。
嵌套于加拿大国家乳腺筛查研究(NBSS)中的病例对照研究。
加拿大NBSS,一项针对加拿大女性乳腺癌筛查的多中心随机对照试验。
病例组为163例死于乳腺癌的女性及57例有远处转移的女性。为每个病例组对象随机选取10名对照对象,对照对象按5岁年龄组、筛查中心、入组年份及随机分配组进行匹配。
入组NBSS前自我报告的BSE频率、项目期间BSE频率的年度自我报告以及BSE技术的年度客观评估。
通过条件多因素逻辑回归模型估计与BSE操作相关的比值比(OR),该模型可对协变量进行控制。
与在诊断前2年接受评估时进行视诊、用指腹触诊且用3根中指检查乳房的女性相比,遗漏这些步骤中的1项、2项或3项的女性死于乳腺癌或发生远处转移疾病的OR为2.20(95%置信区间[CI]1.30至3.71,p = 0.003)。遗漏3项步骤中的1项的女性的OR为1.82(95%CI 1.00至3.29,p = 0.05),遗漏2项的女性为2.84(95%CI 1.44至5.59,p = 0.003),遗漏全部3项的女性为2.95(95%CI 1.19至7.30,p = 0.02)。在对潜在混杂因素进行调整后,结果保持不变。
使用前瞻性收集的数据得出的结果表明,特定BSE步骤的操作可能会降低乳腺癌死亡风险。