Influence of patterns of hormone replacement therapy use and mammographic density on breast cancer detection
Influence of patterns of hormone replacement therapy use and mammographic density on breast cancer detection
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DOI：
10.1158/1055-9965.epi-06-0290
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发表时间：
2006-10-01
影响因子：
3.8
通讯作者：
Boyd, Norman F.
中科院分区：
文献类型：
--
作者：
Chiarelli, Anna M.;Kirsh, Victoria A.;Boyd, Norman F.
背景资料：有证据表明，目前激素替代疗法（HRT）的使用和乳房X线摄影密度等因素可能会降低乳房X线摄影的灵敏度，并与更大的间隔癌症风险相关。本研究探讨了这种关系，进一步检查HRT的使用模式和乳腺癌的检测间隔cancer.Methods分类的乳腺癌的乳腺摄影密度的百分比的影响：本研究采用嵌套在一个队列的妇女筛选的安大略乳腺癌筛查计划在1994年和2002年之间的病例-病例设计。将筛选时遗漏但在回顾性审查中观察到的间期癌症（n = 87）或筛选时无可见肿瘤体征的真实间期（n = 288）与450例筛选检测到的癌症匹配。乳腺摄影密度的百分比，由放射科医生和计算机辅助方法测量，HRT的使用，从邮寄的问卷调查中确定，和被诊断为间隔期癌症的风险之间的关联使用条件logistic regression.Results：乳腺摄影密度每增加25%，间隔期癌症风险增加的单调梯度被发现[比值比（OR），1.77;缺失间期的95%置信区间（95% CI）为1.07-2.95，真实间期的OR为2.16; 95% CI为1.59-2.94]。在调整乳腺摄影密度后，仅服用雌激素的女性患真间隔癌的风险仍显着增加（OR，1.75; 95% CI，1.11-2.83）以及缺失-（OR，2.84; 95% CI，1.32-6.13）和真实间隔期癌症（OR，1.79; 95%CI，1.10-2.90）。结论：应在筛查时常规收集有关乳腺摄影密度和HRT使用的信息。应让有风险的妇女了解乳房X线照相术的敏感性较低，并为她们提供其他筛查程序。
Background: There is evidence that factors such as current hormone replacement therapy (HRT) use and mammographic density may each lower the sensitivity of mammography and are associated with a greater risk of developing an interval cancer. This study explores this relationship further by examining the influence of patterns of HRT use and the percentage of mammographic density on the detection of breast cancer by classification of interval cancer.Methods: This study uses a case-case design nested within a cohort of women screened by the Ontario Breast Screening Program between 1994 and 2002. Interval cancers, both those missed at screening but seen on retrospective review (n = 87) or true intervals without visible tumor signs at screening (n = 288) were matched to 450 screen-detected cancers. The association between the percentage of mammographic density, measured by radiologists and a computer-assisted method, and HRT use, ascertained from a mailed questionnaire, and the risk of being diagnosed with an interval cancer was estimated using conditional logistic regression.Results: A monotonic gradient of increasing risk for interval cancers was found for each 25% increase in mammographic density [odds ratio (OR), 1.77; 95% confidence intervals (95% CI), 1.07-2.95 for missed intervals and OR, 2.16; 95% CI, 1.59-2.94 for true intervals]. After adjusting for mammographic density, a significantly increased risk for true-interval cancers remained for women taking estrogen alone (OR, 1.75; 95% CI, 1.11-2.83) as well as for missed- (OR, 2.84; 95% CI, 1.32-6.13) and true-interval cancers (OR, 1.79; 95% CI, 1.10-2.90) for women taking combined HRT.Conclusions: Information on mammographic density and HRT use should routinely be collected at the time of screening. Women at risk should be made aware of the lower sensitivity of mammography and offered alternative procedures for screening.