The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up
The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up
复制标题
DOI：
10.1002/ijc.30754
复制
发表时间：
2017-08-15
影响因子：
6.4
通讯作者：
de Koning, Harry J.
中科院分区：
文献类型：
--
作者：
Sankatsing, Valerie D. V.;van Ravesteyn, Nicolien T.;de Koning, Harry J.
关于筛查效果的长期随访数据很少，关于筛查与治疗对降低乳腺癌死亡率的相对贡献存在争议。因此，我们的目的是评估按年龄和实施时间进行筛查的长期效果。我们获得了荷兰1980年至2010年期间69，630例乳腺癌死亡的数据，这些数据按城市（N=431）和死亡年龄（40-79）划分。通过将引入筛查的特定生育率日历年定义为第0年，分析乳腺癌死亡率趋势。此外，对数线性泊松回归被用来估计转折点的趋势后，第0年，每个城市，以及每年的百分比变化（APC）之前和之后的这一点。与第0年相比，采用筛查20年后，55-74岁妇女的乳腺癌死亡率降低了30%，75-79岁妇女降低了34%。尽管有效辅助治疗的可获得性不同，但在早（1987-1992年）和晚（1995-1997年）开始筛查的城市，也出现了类似的显著下降。在55-74岁和75-79岁年龄组中，乳腺癌死亡率趋势的转折点估计分别在引入筛查后的第2年和第6年，此后死亡率每年显著下降1.9%和2.6%。这些研究结果表明，在荷兰各城市实施乳房X线摄影筛查与55-79岁女性乳腺癌死亡率的显著下降有关，无论实施时间如何。癌症筛查的长期公共健康影响是什么？没有收集到多少数据来定量回答这个问题。为了找到答案，这些作者收集了荷兰在引入国家筛查计划后20年内乳腺癌死亡率的数据。他们观察到，在筛查开始后，55-74岁的女性乳腺癌死亡率下降了30%。同样，在75-79岁的老年妇女中，死亡率下降了34%。
Long-term follow-up data on the effects of screening are scarce, and debate exists on the relative contribution of screening versus treatment to breast cancer mortality reduction. Our aim was therefore to assess the long-term effect of screening by age and time of implementation. We obtained data on 69,630 breast cancer deaths between 1980 and 2010 by municipality (N=431) and age of death (40-79) in the Netherlands. Breast cancer mortality trends were analyzed by defining the municipality-specific calendar year of introduction of screening as Year 0. Additionally, log-linear Poisson regression was used to estimate the turning point in the trend after Year 0, per municipality, and the annual percentage change (APC) before and after this point. Twenty years after introduction of screening breast cancer mortality was reduced by 30% in women aged 55-74 and by 34% in women aged 75-79, compared to Year 0. A similar and significant decrease was present in municipalities that started early (1987-1992) and late (1995-1997) with screening, despite the difference in availability of effective adjuvant treatment. In the age groups 55-74 and 75-79, the turning point in the trend in breast cancer mortality was estimated in Years 2 and 6 after the introduction of screening, respectively, after which mortality decreased significantly by 1.9% and 2.6% annually. These findings show that the implementation of mammography screening in Dutch municipalities is associated with a significant decline in breast cancer mortality in women aged 55-79, irrespective of time of implementation.What's new? What's the public health impact of cancer screening over the long term? Not much data has been collected to quantitatively answer that. To find out, these authors collected data on breast cancer mortality in the Netherlands over a period of 20 years after the introduction of a national screening program. They observed a 30% decrease in breast cancer mortality among women age 55-74 after screening commenced. Similarly, in older women, age 75-79, mortality decreased by 34%.