Breast density as a predictor of mammographic detection: Comparison of interval- and screen-detected cancers
Breast density as a predictor of mammographic detection: Comparison of interval- and screen-detected cancers
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DOI：
10.1093/jnci/92.13.1081
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发表时间：
2000-07-05
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影响因子：
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通讯作者：
White, E
中科院分区：
文献类型：
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作者：
Mandelson, MT;Oestreicher, N;White, E
背景：筛查钼靶是降低乳腺癌死亡率的最好方法，但有些乳腺癌是钼靶不能发现的，钼靶阴性后确诊的乳腺癌称为间隔癌。这项研究调查了乳房X光检查乳房密度是否与间歇性癌症的风险有关。方法：受试者选自1988年至1993年在华盛顿州西雅图的一家大型健康维护组织参加乳房X光检查的妇女，如果她们在筛查乳房X光检查后24个月内和随后的乳房X光检查之前被诊断出患有第一次原发浸润性乳腺癌，则有资格参加研究。间歇性癌症病例受试者(n=149)是在乳房X光检查阴性或良性评估后发生乳腺癌的妇女。筛查对照受试者(n=388)是在筛查阳性乳房X光照片后被诊断出来的，一名对癌症状况视而不见的放射科医生使用美国放射学会乳房成像报告和数据系统评估了乳房密度。结果：在乳房以脂肪为主的女性中，乳房X光检查的敏感度(即乳房X光检查发现癌症的能力)达到80%，而在乳房密度极高的女性中，敏感度只有30%。在调整了年龄、绝经状况、激素替代治疗和体重指数后，乳房极其致密的女性与乳房极度肥胖的女性相比，患间歇性癌症的优势比(OR)为6.14(95%可信区间[CI]=1.95-19.4)。当仅考虑那些经指数型钼靶X线检查证实的间歇性癌病例时，OR值增加到9.47(95%CI=2.78~32.3)。结论：钼靶摄影显示乳腺密度是间歇性癌的主要危险因素。
Background: Screening mammography is the best method to reduce mortality from breast cancer, yet some breast cancers cannot be detected by mammography, Cancers diagnosed after a negative mammogram are known as interval cancers. This study investigated whether mammographic breast density is related to the risk of interval cancer. Methods: Subjects were selected from women participating in mammographic screening from 1988 through 1993 in a large health maintenance organization based in Seattle, WA, Women were eligible for the study if they had been diagnosed with a first primary invasive breast cancer within 24 months of a screening mammogram and before a subsequent one. Interval cancer case subjects (n = 149) were women whose breast cancer occurred after a negative or benign mammographic assessment. Screen-detected control subjects (n = 388) were diagnosed after a positive screening mammogram, One radiologist, who was blinded to cancer status, assessed breast density by use of the American College of Radiology Breast Imaging Reporting and Data System. Results: Mammographic sensitivity (i.e., the ability of mammography to detect a cancer) was 80% among women with predominantly fatty breasts but just 30% in women with extremely dense breasts. The odds ratio (OR) for interval cancer among women with extremely dense breasts was 6.14 (95% confidence interval [CI] = 1.95-19.4), compared with women with extremely fatty breasts, after adjustment for age at index mammogram, menopausal status, use of hormone replacement therapy, and body mass index. When only those interval cancer cases confirmed by retrospective review of index mammograms were considered, the OR increased to 9.47 (95% CI = 2.78-32.3), Conclusion: Mammographic breast density appears to be a major risk factor for interval cancer.