Effect of NHS breast screening programme on mortality from breast cancer in England and Wales, 1990-8: comparison of observed with predicted mortality
Effect of NHS breast screening programme on mortality from breast cancer in England and Wales, 1990-8: comparison of observed with predicted mortality
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DOI：
10.1136/bmj.321.7262.665
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发表时间：
2000-09-16
影响因子：
--
通讯作者：
Babb, PJ
中科院分区：
文献类型：
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作者：
Blanks, RG;Moss, SM;Babb, PJ
目的 评估 NHS 乳腺筛查计划对 1990-8 年间 55-69 岁女性乳腺癌死亡率的影响。使用 1971-89 年的数据设计年龄队列模型，用于预测 1990-8 年的死亡率，假设直到 1989 年之后筛查或治疗改进不会产生重大影响。通过将观察到的死亡率的三年移动平均值与预测的死亡率（按五年计算）进行比较，估计筛查和其他因素对死亡率的影响。 年龄组从 50-54 岁到 75-79 岁），筛查的效果仅限于某些年龄组。设置英格兰和威尔士。受试者年龄为 40 至 79 岁的女性。结果与没有筛查或其他影响的情况下的预测死亡率相比，1998 年 55-69 岁女性乳腺癌死亡率估计下降了 21.3%。筛查的直接影响估计为 6.4%（估计范围为 5.4-11.8%）。所有其他因素（改善他莫昔芬和化疗的治疗，以及在筛查计划之外更早就诊）的影响估计为 14.9%（范围 12.2-14.9%）。 结论 到 1998 年，筛查和其他因素（包括治疗的改进）已导致乳腺癌死亡率大幅下降。 20 世纪 90 年代的许多死亡病例是在 20 世纪 80 年代和 90 年代初诊断出来的女性，当时还没有接受筛查。预计筛查和治疗会产生进一步的重大影响，再加上队列效应，将导致未来 10 年内乳腺癌死亡率进一步大幅下降，特别是 55-69 岁的女性。
Objective To assess the impact of the NHS breast screening programme on mortality from breast cancer in women aged 55-69 years over the period 1990-8.Design Age cohort model with data for 1971-89 used to predict mortality for 1990-8 with assumption of no major effect from screening or improvements in treatment until after 1989. Effect of screening and other factors on mortality estimated by comparing three year moving averages of observed mortality with those predicted (by five year age groups from 50-54 to 75-79), the effect of screening being restricted to certain age groups.Setting England and Wales.Subjects Women aged 40 to 79 years.Results Compared with predicted mortality in the absence of screening or other effects the total reduction in mortality from breast cancer in 1998 in women aged 55-69 was estimated as 21.3%. Direct effect of screening was estimated as 6.4% (range of estimates from 5.4-11.8%). Effect of all other factors (improved treatment with tamoxifen and chemotherapy, and earlier presentation outside the screening programme) was estimated as 14.9% (range 12.2-14.9%).Conclusions By 1998 both screening and other factors, including improvements in treatment, had resulted in substantial reductions in mortality from breast cancer. Many deaths in the 1990s will be of women diagnosed in the 1980s and early 1990s, before invitation to screening. Further major effects from screening and treatment are expected, which together with cohort effects should result in further substantial reductions in mortality from breast cancer, particularly for women aged 55-69, over die next 10 years.