Effect of estrogen replacement therapy on the specificity and sensitivity of screening mammography
Effect of estrogen replacement therapy on the specificity and sensitivity of screening mammography
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DOI：
10.1093/jnci/88.10.643
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发表时间：
1996-05-15
期刊：
影响因子：
--
通讯作者：
White, E
中科院分区：
文献类型：
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作者：
Laya, MB;Larson, EB;White, E
背景资料：以往的研究表明，乳腺钼靶摄影乳腺密度增加后，开始雌激素替代治疗（ERT）。这种密度增加对筛查性乳腺X射线摄影的特异性（与假阳性读数相关）和灵敏度（与假阴性读数相关）的影响（如果有的话）尚不清楚，目的：采用回顾性队列研究设计，我们评估了ERT对筛查性乳腺X射线摄影的特异性和灵敏度的影响。研究方法：参与者（n = 8779）为绝经后妇女，年龄50岁或以上，谁参加了健康维护组织位于西部华盛顿州和谁进入乳腺癌筛查计划之间的1988年1月和1993年6月。双视图乳房X线摄影作为全面乳腺癌筛查访视的一部分进行。通过自我管理的问卷记录月经状况以及人口统计学和风险因素信息。激素替代疗法的类型和使用由问卷调查数据和药房记录的自动审查确定。在第一次筛查计划乳房X光检查后12个月内被诊断为乳腺癌的个人通过使用区域癌症登记处进行识别。计算当前和以前ERT使用者（从未使用者作为参考组）假阳性和假阴性检查的风险比（RR）和95%置信区间（CI）。报告的P值为双侧。结果：目前使用ERT的乳腺X线筛查的特异性低于从未使用者或以前使用者。将阳性乳房X线摄影阅读定义为任何不正常的阅读（怀疑癌症或不确定），当前使用者与从未使用者的假阳性阅读的校正RR（95% CI）为1.33（1.15-1.54）（P < .001）;对于以前使用者与从未使用者，RR（95% CI）为1.00（0.87-1.15）。从未使用过ERT、既往使用过ERT和当前使用ERT的调整后乳房X线摄影特异性（95% CI）分别为86%（84%-88%）、86%（84%-87%）和82%（80%-84%）。更严格地定义正阅读（即，仅怀疑为癌症），当前使用者和以前使用者（与从未使用者相比）的假阳性读数的校正RR（95%CI）分别为1.71（1.37-2.14）（P < .001）和1.16（0.93-1.45）。目前接受ERT治疗的女性的敏感性也较低。当前使用者与从未使用者的假阴性阅读的未校正RR（95% CI）为5.23（1.09-25.02）（P = 0.04）;对于既往使用者与从未使用者，RR（95% CI）为1.06（0.10-10.87）。从未使用过ERT、既往使用过ERT和当前使用ERT的未校正乳房X线摄影灵敏度（95% CI）分别为94%（80%-99%）、94%（69%-99%）和69%（38%-91%）。结论和意义：目前使用的ERT与乳腺X线筛查的低特异性和低敏感性相关。较低的特异性可能会增加乳腺癌筛查的成本，而较低的敏感性可能会降低其有效性。
Background: Previous studies have demonstrated that mammographic breast density increases following the initiation of estrogen replacement therapy (ERT). The effect, if any, that this increase in density has on the specificity (related to false-positive readings) and the sensitivity (related to false-negative readings) of screening mammography is unknown, Purpose: Using a retrospective cohort study design, we assessed the effects of ERT on the specificity and the sensitivity of screening mammography. Methods: Participants (n = 8779) were postmenopausal women, aged 50 years or older, who were enrolled in a health maintenance organization located in western Washington state and who entered a breast cancer screening program between January 1988 and June 1993. Two-view mammography was performed as part of a comprehensive breast cancer screening visit. Menopausal status, as well as demographic and risk-factor information, was recorded via self-administered questionnaires. Hormonal replacement therapy type and use were determined from questionnaire data and from an automated review of pharmacy records. Individuals diagnosed with breast cancer within 12 months of their first screening-program mammograms were identified through use of a regional cancer registry. Risk ratios (RRs) plus 95% confidence intervals (CIs) of false-positive as well as false-negative examinations among current and former ERT users (with never users as the reference group) were calculated. Reported P values are two-sided. Results: The specificity of mammographic screening was lower for current users of ERT than for never users or former users. Defining a positive mammographic reading as any non-normal reading (either suspicious for cancer or indeterminate), the adjusted RR (95% CI) of a false-positive reading for current users versus never users was 1.33 (1.15-1.54) (P < .001); for former users versus never users, the RR (95% CI) was 1.00 (0.87-1.15). The adjusted mammographic specificities (95% CIs) for never users, former users, and current users of ERT were 86% (84%-88%), 86% (84%-87%), and 82% (80%-84%), respectively. Defining a positive reading more rigorously (i.e., as suspicious for cancer only), the adjusted RRs (95% CIs) of false-positive readings for current users and former users (versus never users) were 1.71 (1.37-2.14) (P < .001) and 1.16 (0.93-1.45), respectively. Sensitivity was also lower in women currently receiving ERT. The unadjusted RR (95% CI) of a false-negative reading for current users versus never users was 5.23 (1.09-25.02) (P = .04); for former users versus never users, the RR (95% CI) was 1.06 (0.10-10.87). The unadjusted mammographic sensitivities (95% CI) for never users, former users, and current users of ERT were 94% (80%-99%), 94% (69%-99%), and 69% (38%-91%), respectively. Conclusions and Implications: Current use of ERT is associated with lower specificity and lower sensitivity of screening mammography. Lower specificity could increase the cost of breast cancer screening, and lower sensitivity may decrease its effectiveness.