Field L R, Wilson T E, Strawderman M, Gabriel H, Helvie M A
University of Michigan Hospitals, Department of Radiology, Ann Arbor 48109-0326, USA.
AJR Am J Roentgenol. 1998 Apr;170(4):961-5. doi: 10.2214/ajr.170.4.9530044.
The purpose of our study was to determine if annual mammographic screening was superior to biennial screening in women more than 64 years old by examining differences in various prognostic indicators.
We reviewed the records of 119 consecutive women 65 years old and older with 120 cases of breast cancer who had a previous normal screening evaluation for breast cancer that included mammography and physical examination 8-30 months before diagnosis. A search of the computerized tumor registry, clinical records, and breast imaging records from November 1988 to April 1995 provided our cases. Screening intervals were defined as 6-18 months (annual) and 19-30 months (biennial). Mammographic, histologic, and clinical features were reviewed. Disease severity (DS) levels were assigned to each tumor as follows: DS-1 included minimal disease (ductal carcinoma in situ [TisNO], T1aN0, and T1bN0 tumors), DS-2 included all T1cN0 tumors, DS-3 included tumors larger than 2 cm in diameter with lymph nodes that were negative for cancer, and DS-4 included all metastatic disease. Statistically significant differences were calculated using the Wilcoxon rank sum test, Fisher's exact test, and the chi-square test.
Ninety-three tumors were found in the group of patients who were annually screened, and 27 were found in the group of patients who were screened biennially. The women who underwent yearly screening mammography had significantly smaller invasive tumors (average, 10.7 mm; median, 9.5 mm versus 16.5 mm and 15.0 mm, respectively; p = .0086). The women who were screened annually also had significantly less advanced disease than women screened biennially (annually screened patients versus biennially screened patients: DS-1, 72% versus 44%; DS-2, 23% versus 37%; DS-3, 2% versus 11%; DS-4, 3% versus 7%; p = .0071). The group of patients screened annually had fewer cases of lymph node metastases (3% versus 8%; p = .12) and three times as many cases of ductal carcinoma in situ (22% versus 7%, p = .10).
Annual screening mammography revealed significantly smaller tumors and less advanced cases of cancer than biennial screening, providing inferential support for annual mammographic screening of women more than 64 years old.
我们研究的目的是通过检查各种预后指标的差异，确定在64岁以上女性中，年度乳腺钼靶筛查是否优于两年一次的筛查。
我们回顾了119例连续的65岁及以上患有120例乳腺癌的女性的记录，这些女性在诊断前8 - 30个月曾进行过包括乳腺钼靶和体格检查在内的正常乳腺癌筛查评估。通过检索1988年11月至1995年4月的计算机化肿瘤登记、临床记录和乳腺影像记录来获取我们的病例。筛查间隔定义为6 - 18个月（每年一次）和19 - 30个月（每两年一次）。对乳腺钼靶、组织学和临床特征进行了回顾。为每个肿瘤分配疾病严重程度（DS）级别如下：DS - 1包括微小疾病（导管原位癌[TisNO]、T1aN0和T1bN0肿瘤），DS - 2包括所有T1cN0肿瘤，DS - 3包括直径大于2 cm且淋巴结无癌转移的肿瘤，DS - 4包括所有转移性疾病。使用Wilcoxon秩和检验、Fisher精确检验和卡方检验计算统计学上的显著差异。
在每年接受筛查的患者组中发现93个肿瘤，在每两年接受筛查的患者组中发现27个肿瘤。每年接受乳腺钼靶筛查的女性侵袭性肿瘤明显更小（平均10.7 mm；中位数9.5 mm，而分别为16.5 mm和15.0 mm；p = 0.0086）。每年接受筛查的女性的疾病进展程度也明显低于每两年接受筛查的女性（每年接受筛查的患者与每两年接受筛查的患者：DS - 1，72%对44%；DS - 2，23%对37%；DS - 3，2%对11%；DS - 4，3%对7%；p = 0.0071）。每年接受筛查的患者组淋巴结转移病例较少（3%对8%；p = 0.12），导管原位癌病例数是每两年接受筛查患者组的三倍（22%对7%，p = 0.10）。
与每两年一次的筛查相比，年度乳腺钼靶筛查发现的肿瘤明显更小，癌症进展程度更低，为64岁以上女性进行年度乳腺钼靶筛查提供了推断性支持。
