Incidence, Characteristics, and Outcomes of Interval Breast Cancers Compared With Screening-Detected Breast Cancers.
Incidence, Characteristics, and Outcomes of Interval Breast Cancers Compared With Screening-Detected Breast Cancers.
复制标题
DOI：
10.1001/jamanetworkopen.2020.18179
复制
发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Decker K
中科院分区：
文献类型：
--
作者：
Niraula S;Biswanger N;Hu P;Lambert P;Decker K
在参加人群筛查计划的妇女中，通过乳房X光检查发现的乳腺癌与筛查乳房X光检查(间歇性癌症)发现的乳腺癌在特征和结果上有什么不同和相似之处？在这项对69名 025名女性进行的队列研究中，间歇期乳腺癌占常规筛查女性乳腺癌的四分之一，三级乳腺癌的可能性是后者的6倍，与筛查发现的癌症相比，乳腺癌死亡风险增加了3.5倍。乳腺癌的异质性打破了目前筛查乳房X光检查最有效所必需的假设；需要常规筛查乳房X光检查之外的策略来预防、检测和避免更致命的间歇性乳腺癌的死亡。这项基于人群的队列研究检查了与间歇性乳腺癌相关的乳腺癌特异性死亡率，并与筛查发现的乳腺癌进行了比较。乳腺癌包括一组高度异质性的疾病。许多乳腺癌，特别是更致命的乳腺癌，可能不符合关于乳腺癌生物学和自然病史的假设，这是筛查乳房X光检查有效所必需的。目的比较正常筛查乳腺癌(间歇性乳腺癌[IBC])和筛查乳腺癌(SBC)2年内确诊的乳腺癌的肿瘤特征，比较IBC和SBC的乳腺癌特异性死亡率。在这项基于登记的队列研究中，我们收集了2004年1月至2010年6月期间在加拿大马尼托巴省参加基于人群的筛查计划的乳腺癌患者和该省筛查计划之外的乳腺癌患者的相关肿瘤和患者相关变量的数据。我们进行了多项Logistic回归分析，以评估与诊断IBC和SBC相关的肿瘤和患者特征。采用竞争风险分析方法检测癌症患者的死亡风险。乳腺癌诊断。肿瘤特征和乳腺癌特异性死亡率的差异。在研究期间，共有69名年龄在50岁至之间的 025女性接受了212次 579筛查乳房X光检查。共有1687例乳腺癌诊断(705例SBC，206例IBC，275例不符合筛查计划，501例在筛查计划外被检测到)，225例死亡(170例乳腺癌特有的死亡)。间歇性癌的高级别和雌激素受体阴性的可能性高于小细胞癌(OR分别为6.33；95%CI，3.73~10.75；P <； .001；和OR，2.88；95%CI，2.01~4.13；P <； .001)。经过7年的中位随访期，在两年的时间里，与小细胞肺癌相比，乳癌患者的乳腺癌特异性死亡率显著更高(风险比[HR]3.55；95%可信区间2.01-6.28；P <； .001)。IBC和SBC的非乳腺癌死亡率相似(HR，1.33；95%CI，0.43-4.15)。在这项队列研究中，间歇性癌症在参与人群筛查的女性中高度流行，代表了更糟糕的生物学特征，并且乳腺癌死亡的风险是SBC的3倍以上。需要超越目前乳房X光检查做法的策略，以减少这些潜在致命乳腺癌的发病率、提高检测和减少死亡。
What are the differences and similarities in characteristics and outcomes of breast cancers detected by mammographic screening vs those detected between screening mammograms (interval cancers) in women participating in a population-based screening program? In this cohort study of 69 025 women, interval breast cancers accounted for one-fourth of breast cancers in routinely screened women, were 6 times more likely to be grade III, and had 3.5 times increased hazards of breast cancer death compared with screen-detected cancers. Heterogeneity in breast cancer defies assumptions necessary for screening mammography in its current form to be maximally effective; strategies beyond routine screening mammography are needed to prevent, detect, and avert deaths from the more lethal interval breast cancers. This population-based cohort study examines breast cancer–specific mortality rates associated with interval breast cancer compared with those of screen-detected breast cancers. Breast cancer comprises a highly heterogeneous group of diseases. Many breast cancers, particularly the more lethal ones, may not satisfy the assumptions about biology and natural history of breast cancer necessary for screening mammography to be effective. To compare tumor characteristics of breast cancers diagnosed within 2 years of a normal screening mammogram (interval breast cancer [IBC]) with those of screen-detected breast cancers (SBC) and to compare breast cancer–specific mortality of IBC with SBC. In this registry-based cohort study, we collected data about relevant tumor- and patient-related variables on women diagnosed with breast cancer between January 2004 and June 2010 who participated in the population-based screening program in Manitoba, Canada, and those diagnosed with breast cancer outside the screening program in the province. We performed multinomial logistic regression analysis to assess tumor and patient characteristics associated with a diagnosis of IBC compared with SBC. Competing risk analysis was performed to examine risk of death by cancer detection method. Breast cancer diagnosis. Differences in tumor characteristics and breast cancer–specific mortality. A total of 69 025 women aged 50 to 64 years had 212 579 screening mammograms during the study period. There were 1687 breast cancer diagnoses (705 SBC, 206 IBC, 275 were noncompliant, and 501 were detected outside the screening program), and 225 deaths (170 breast cancer–specific deaths). Interval cancers were more likely than SBC to be of high grade and estrogen receptor negative (odds ratio [OR], 6.33; 95% CI, 3.73-10.75; P < .001; and OR, 2.88; 95% CI, 2.01-4.13; P < .001, respectively). After a median follow-up of 7 years, breast cancer–specific mortality was significantly higher for IBC compared with SBC cancers (hazard ratio [HR] 3.55; 95% CI, 2.01-6.28; P < .001), for a sojorn time of 2 years. Non–breast cancer mortality was similar between IBC and SBC (HR, 1.33; 95% CI, 0.43-4.15). In this cohort study, interval cancers were highly prevalent in women participating in population screening, represented a worse biology, and had a hazard for breast cancer death more than 3-fold that for SBC. Strategies beyond current mammographic screening practices are needed to reduce incidence, improve detection, and reduce deaths from these potentially lethal breast cancers.
登录
查看更多内容
影响因子：
10.3
作者：
Kirsh, Victoria A.;Chiarelli, Anna M.;Boyd, Norman F.
通讯作者：
Boyd, Norman F.
影响因子：
3.8
作者：
Defossez, Gautier;Quillet, Alexandre;Ingrand, Pierre
通讯作者：
Ingrand, Pierre
影响因子：
105.7
作者：
Kalager, Mette;Tamimi, Rulla M.;Adami, Hans-Olov
通讯作者：
Adami, Hans-Olov
DOI：
10.1016/0021-9681(87)90095-6
发表时间：
1987-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
ROOS, LL;NICOL, JP;CAGEORGE, SM
通讯作者：
CAGEORGE, SM
影响因子：
5
作者：
Duffy, Stephen W.;Nagtegaal, Iris D.;Lawrence, Gill
通讯作者：
Lawrence, Gill