Followup after 11 years - update of mortality results in the Stockholm mammographic screening trial
Followup after 11 years - update of mortality results in the Stockholm mammographic screening trial
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DOI：
10.1023/a:1005872617944
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发表时间：
1997-09-01
影响因子：
3.8
通讯作者：
Rutqvist, LE
中科院分区：
文献类型：
--
作者：
Frisell, J;Lidbrink, E;Rutqvist, LE
几项随机乳房x光检查试验的结果表明，至少对50岁以上的妇女进行乳房x光检查，有可能降低乳腺癌的死亡率。本文的目的是在11年的随访后，提供斯德哥尔摩试验中研究组和对照组乳腺癌死亡率的数据，以分析哪个年龄组从筛查中获益最多。1981年3月，斯德哥尔摩40,318名年龄在40至64岁之间的女性参加了一项随机试验，仅通过单视图乳房x光检查进行乳腺癌筛查，而对照组的2万名女性则不进行干预。进行了两轮筛查，两轮的出勤率均在80%以上。1986年，对照组被邀请参加一次筛查。研究组和对照组分别确诊乳腺癌428例和217例。在平均11.4年的随访后，观察到整个研究组的死亡率降低了26%，乳腺癌死亡的相对风险（RR）为0.74 （CI（置信区间）= 0.5-1.1）。50-64岁女性的死亡率显著降低38%，RR为0.62 （CI = 0.38-1.0）。对于40-49岁的女性，没有发现对死亡率的影响，乳腺癌死亡的RR为1.08 （CI = 0.54-2.17）。在本研究中，当对5岁年龄组进行分析时，获益的断点似乎是在50岁，但这种趋势是不确定的，因为对较年轻年龄组的分析统计效力较低。较长的筛查间隔，单次乳房x光检查的使用，以及40-49岁年龄组中超过50%的女性在研究结束时仍低于50岁，这些都是可能影响40-49岁年龄组结果的事实。需要更大规模的研究来回答乳房x光检查是否能在年轻人群中成功的问题。
Results from several randomised mammography screening trials have shown that it is possible to reduce mortality in breast cancer by mammographic screening at least for women above 50 years of age. The purpose of this article is to present data on mortality in breast cancer in study and control groups of the Stockholm trial after 11 years of followup, to analyse which age group benefits most from screening. In March 1981, 40, 318 women in Stockholm, aged 40 through 64 years, entered a randomized trial of breast cancer screening by single view mammography alone, versus no intervention in a control group of 20 000 women. Two screening rounds were performed and the attendance rate was over 80% in the two rounds. During 1986 the control group was invited once to screening. Totally 428 and 217 cases of breast cancer were diagnosed in the study and control groups respectively. After a mean follow-up of 11.4 years a nonsignificant mortality reduction of 26% was observed for the whole study group, with a relative risk (RR) of death in breast cancer of 0.74 (CI(confidence interval) = 0.5-1.1). For women aged 50-64 years a significant 38% mortality reduction was observed with a RR of 0.62 (CI = 0.38-1.0). For women aged 40-49 years no effect on mortality was found, with a RR of death in breast cancer of 1.08 (CI = 0.54-2.17). The breakpoint for benefit in this study seemed to be at 50 years of age when 5-year age groups were analysed, but this tendency is uncertain because of the low statistical power in the analysis of the younger age groups. Long screening intervals, the use of single-view mammography, and the fact that more than 50% of the women in age group 40-49 years were still below 50 years of age when the study was closed, were all facts that could have influenced the results in age group 40-49 years. Larger studies are needed to answer the question whether mammographic screening can be successful in younger age groups.