All-Cause Mortality Is Decreased in Women Undergoing Annual Mammography Before Breast Cancer Diagnosis
All-Cause Mortality Is Decreased in Women Undergoing Annual Mammography Before Breast Cancer Diagnosis
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DOI：
10.2214/ajr.14.12666
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发表时间：
2015-04-01
影响因子：
5
通讯作者：
Onitilo, Adedayo A.
中科院分区：
文献类型：
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作者：
Engel, Jessica M.;Stankowski-Drengler, Trista J.;Onitilo, Adedayo A.
OBJECTIVE.每年乳房X光检查的价值仍然是一个有争议的领域，因为担心风险与收益。由于过度诊断和治疗临床上不重要的癌症而造成的潜在危害可能无法通过乳腺癌特异性死亡率来捕获。相反，我们研究了全因死亡率作为乳腺癌诊断前错过年度乳房X线检查的函数。对2002年至2008年在马什菲尔德诊所卫生系统诊断的原发性乳腺癌病例进行回顾性分析，并评估诊断前5年内是否进行了年度乳腺X线检查。对1421例乳腺癌患者进行了分析。在调整了年龄、合并症、乳腺癌家族史、保险状况、医疗就诊频率和日历年的数据后，与没有错过乳房X线检查的受试者相比，错过前5次乳房X线检查的女性的全因死亡风险增加了2.3倍。（风险比= 2.28; 95% CI，1.58-3.30; p < 0.0001）。此外，对每年错过的乳腺X线摄影检查次数的分析显示，随着错过的乳腺X线摄影检查次数的增加，风险逐渐增加。这些结果表明，乳腺癌诊断前每年进行一次乳房X光检查可预测总生存率的增加。每增加一次遗漏的乳腺X线摄影检查，总生存率逐步下降。这些结果与文献中乳腺癌特异性死亡率的结果相似，并说明了向所有符合条件的女性推荐每年进行乳房X线检查的重要性。
OBJECTIVE. The value of annual mammography remains an area of debate because of concerns regarding risk versus benefit. The potential for harm due to overdiagnosis and treatment of clinically insignificant cancers may not be captured by breast cancer-specific mortality. Instead, we examined all-cause mortality as a function of missed annual mammography examinations before breast cancer diagnosis.MATERIALS AND METHODS. Primary breast cancer cases diagnosed in the Marshfield Clinic Health System from 2002 through 2008 were identified for retrospective review, and whether annual mammography examinations had been performed in the 5 years before diagnosis was assessed.RESULTS. Analyses were performed on 1421 women with breast cancer. After adjustment of data for age, comorbidity status, a family history of breast cancer, insurance status, medical encounter frequency, and the calendar year, women who had missed any of the previous five annual mammography examinations had a 2.3-fold increased risk of all-cause mortality compared with subjects with no missed mammography examinations (hazard ratio = 2.28; 95% CI, 1.58-3.30; p < 0.0001). Additionally, an analysis by the number of missed annual mammography examinations showed a progressive increase in hazard as the number of missed mammography studies increased.CONCLUSION. These results suggest that annual mammography before breast cancer diagnosis is predictive of increased overall survival. A stepwise decline in overall survival was noted for each additional missed mammography examination. These results are similar to findings in the literature for breast cancer-specific mortality and illustrate the importance of recommending annual mammography to all eligible women.