The relative contributions of screen-detected in situ and invasive breast carcinomas in reducing mortality from the disease
The relative contributions of screen-detected in situ and invasive breast carcinomas in reducing mortality from the disease
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DOI：
10.1016/s0959-8049(03)00259-4
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发表时间：
2003-08-01
影响因子：
8.4
通讯作者：
Yen, MFA
中科院分区：
文献类型：
--
作者：
Duffy, SW;Tabar, L;Yen, MFA
我们的目的是量化乳腺摄影筛查中检测导管原位癌（DCIS）和浸润性肿瘤中向下转移的益处。利用瑞典两县乳腺癌筛查试验的数据，我们检查了II期或更严重的侵袭性肿瘤、I期侵袭性肿瘤和DCIS的20年死亡率。然后，我们使用这些发生率及其在试验邀请组（主动研究人群，ASP）和对照组（被动研究人群，PSP）中的相应发生率，估计通过将较大的II期或更严重的肿瘤向下转移到I期以及将I期癌症转移到DCIS而避免的死亡人数。我们还研究了在乳腺癌筛查随机试验中所实现的死亡率降低与DCIS病例比例之间的关系。在瑞典两县试验中，与PSP相比，ASP在大约20年的随访中避免了141例乳腺癌死亡。其中，65%（91/141）由于从侵袭性II期或更差的分期转移到侵袭性I期而避免，5%（7/141）由于从侵袭性I期转移到DCIS而避免。如果我们假设避免的II期或更严重的肿瘤中有10%不是转移到I期，而是转移到DCIS，则通过从侵袭性疾病转移到原位预防的死亡人数估计为17人，占所有预防死亡人数的12%。当回顾所有乳腺癌筛查随机试验的结果时，DCIS病例诊断百分比与观察到的死亡率降低之间没有明确的联系。我们的结论是，与侵袭性肿瘤的向下阶段转移相比。DCIS的检测在挽救乳腺癌患者的生命方面起着很小的作用。DCIS的治疗决定，如浸润性癌，应充分考虑肿瘤的组织病理学，临床和放射学属性。(C)2003爱思唯尔有限公司。保留所有权利。
We aimed to quantify the benefits of detecting ductal carcinoma in situ (DCIS) and of downwards stage-shifting within invasive tumours in mammographic screening. Using data from the Swedish Two-County Trial of breast cancer screening, we examined the 20-year death rates from invasive tumours of stage II or worse, invasive tumours of stage I and DCIS. We then used these rates and their respective incidences in invited (active study population, ASP) and control (passive study population, PSP) arms of the trial, to estimate the numbers of deaths avoided by downward stage-shifting the larger stage II or worse tumours to stage I and the stage I cancers to DCIS. We also studied the association between the mortality reduction achieved and the proportion of DCIS cases detected in the randomised trials of breast cancer screening. In the Swedish Two County Trial, 141 breast cancer deaths were avoided in the ASP compared with the PSP at approximately 20 years of follow-up. Of these, 65% (91/141) were avoided as a result of stage-shifting from invasive stage II or worse to invasive stage I, and 5% (7/141) as a result of stage-shifting from invasive stage I to DCIS. If we assumed that 10% of stage II or worse tumours avoided were shifted not to stage I, but to DCIS, the estimated number of deaths prevented by shifting from invasive disease to in situ was 17, which is 12% of all deaths prevented. When the results of all the randomised trials of breast cancer screening were reviewed, there was no clear association between the percentage of DCIS cases diagnosed and the observed mortality reduction. We conclude that compared with downward stage-shifting of invasive tumours. detection of DCIS plays a small part in saving lives from breast cancer. Treatment decisions in DCIS, as in invasive carcinoma, should take full account of histopathological, clinical and radiological attributes of the tumour. (C) 2003 Elsevier Ltd. All rights reserved.