Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography
Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography
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DOI：
10.7326/0003-4819-138-3-200302040-00008
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发表时间：
2003-02-04
影响因子：
39.2
通讯作者：
Ballard-Barbash, R
中科院分区：
文献类型：
--
作者：
Carney, PA;Miglioretti, DL;Ballard-Barbash, R
背景资料：乳腺密度、年龄和激素替代疗法（HRT）在乳腺癌检测中的应用之间的关系尚未得到充分评价。目的：确定乳腺密度、年龄和HRT单独或联合使用如何影响筛查性乳腺X线摄影的准确性。设计：前瞻性队列研究。设置：7个基于人群的乳腺X线摄影登记处，分别位于北卡罗来纳州、新墨西哥州、新罕布什尔州、佛蒙特州、科罗拉多、佛蒙特州、科罗拉多州、佛蒙特州、新罕布什尔州、新罕布什尔州。西雅图，华盛顿;和旧金山弗朗西斯科，加州。参与者：329495名40至89岁的妇女，从1996年至1998年进行了463372次筛查性乳房X线摄影; 2223名妇女接受了乳腺癌诊断。测量：乳腺密度，年龄，HRT使用，乳腺癌发生率，筛查性乳房X线摄影的敏感性和特异性。结果：调整后的敏感性范围从62.9%的女性非常致密的乳房，几乎完全脂肪乳房的女性87.0%;调整后的敏感性随着年龄的增长而增加，从68.6%的女性40至44岁，80至89岁的女性83.3%。调整后的特异性从极致密乳房的89.1%增加到几乎完全脂肪乳房的96.9%。在未使用HRT的女性中，调整后的特异性从40 - 44岁女性的91.4%增加到80 - 89岁女性的94.4%。在妇女谁使用HRT，调整后的特异性约为91.7%，为所有年龄段。结论：乳腺钼靶摄影乳腺密度和年龄是重要的预测指标的准确性筛查乳腺钼靶摄影。虽然HRT的使用不是准确性的独立预测因素，但它可能会通过增加乳腺密度来影响准确性。
Background: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated.Objective: To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography.Design: Prospective cohort study.Setting: 7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California.Participants: 329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer.Measurements: Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography.Results: Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages.Conclusions: Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density.