Prognosis in women with interval breast cancer: population based observational cohort study
Prognosis in women with interval breast cancer: population based observational cohort study
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DOI：
10.1136/bmj.e7536
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发表时间：
2012-11-16
影响因子：
105.7
通讯作者：
Adami, Hans-Olov
中科院分区：
文献类型：
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作者：
Kalager, Mette;Tamimi, Rulla M.;Adami, Hans-Olov
目的比较间歇期乳腺癌(在常规筛查后和下一次定期钼靶检查前发现的乳腺癌)和未被邀请进行乳房摄影筛查的妇女(未筛查)的预后。设计以人群为基础的观察性研究。制定1996年至2005年在不同县实施的挪威乳腺癌筛查计划。研究对象为7116名确诊为乳腺癌的50~72岁妇女；1816人患有间歇性乳腺癌，5300人被诊断为乳腺癌，但尚未被邀请进行筛查。主要结果采用Kaplan Meier曲线和多变量Cox比例风险模型衡量乳腺肿瘤的特征和女性的生存。结果虽然间歇性癌症的平均体积略大于未被邀请筛查的女性，但两组之间腋窝淋巴结的组织类型或状态没有明显差异。在间歇性癌症中，没有明显的大小、结节状态、分级或激素受体阳性与自上次正常乳房X光检查作为生长速度标志以来的时间相关。随访10年后，间歇性癌症患者的生存率为79.1%(95%可信区间为75.4%~82.3%)，未筛查癌症患者的生存率为76.8%(95%可信区间为75.3%~78.2%)(危险比0.98，95%可信区间为0.84~1.15；P=0.53)。结论间歇期乳腺癌患者的预后与未行钼靶检查的乳腺癌患者的预后相同。
Objective To compare the prognosis in women with interval breast cancer (cancer detected after a normal screening mammogram and before the next scheduled mammogram) with breast cancer detected among women not yet invited to mammography screening (non-screened).Design Population based observational study.Setting Norwegian breast cancer screening programme, implemented in different counties from 1996 to 2005.Participants 7116 women with a diagnosis of breast cancer at age 50 to 72 years; 1816 had interval breast cancer and 5300 had a diagnosis of breast cancer but had not yet been invited to screening.Main outcome measures Characteristics of the breast tumours, and survival of the women using Kaplan Meier curves and multivariable Cox proportional hazard models.Results Although interval cancers on average were slightly larger than the cancers in women not invited to screening, the histological type or status of axilliary lymph nodes did not differ noticeably between the two groups. Among interval cancers, there were no appreciable trends in size, nodal status, grade, or hormone receptor positivity associated with time since the last normal mammogram as a marker of growth rate. After 10 years of follow-up, the survival rates were 79.1% (95% confidence interval 75.4% to 82.3%) among women with interval cancers and 76.8% (75.3% to 78.2%) among women in the non-screened cancer group (hazard ratio 0.98, 95% confidence interval 0.84 to 1.15; P=0.53). Analyses stratified by time since last normal mammogram, age at diagnosis, or screening round showed similar results.Conclusion The prognosis of women with interval breast cancers was the same as that of women with breast cancers diagnosed without mammography screening.