AGGRESSIVENESS OF BREAST CANCERS FOUND WITH AND WITHOUT SCREENING
AGGRESSIVENESS OF BREAST CANCERS FOUND WITH AND WITHOUT SCREENING
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DOI：
10.1136/bmj.304.6825.467
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发表时间：
1992-02-22
影响因子：
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通讯作者：
PARVINEN, I
中科院分区：
文献类型：
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作者：
KLEMI, PJ;JOENSUU, H;PARVINEN, I
目的-研究乳腺摄影筛查发现的乳腺癌与筛查外发现的乳腺癌有何不同。设计-比较队列研究。背景-图尔库，患者-在1987-90年第一轮乳房X线摄影筛查期间检测到的126名40-74岁患有乳腺癌的妇女和125名相同年龄范围内患有乳腺癌的妇女-主要结果测量-原发肿瘤大小，腋窝淋巴结状态，组织学特征，雌激素和孕激素受体浓度，倍性，结果：与对照组相比，筛查发现的癌症妇女的原发肿瘤较小（57例（46%）），筛选的V11（10%）对照具有直径小于或等于11 mm的肿瘤，p < 0.0001），并且较少具有腋窝淋巴结转移（104（83%）筛选的V71（57%）对照淋巴结阴性，p < 0.0001）。与对照组相比，在对原发肿瘤的较小尺寸进行调整后，通过筛查检测到的那些癌症不太可能有腋窝淋巴结转移（比值比0.44，95%置信区间0.23 - 0.84），组织学分化差（0.20，0.08至0.49），高核分裂计数（0.38，0.15至0.97），肿瘤坏死（0.45，0.22至0.93）或导管组织学类型（0.46，0.22至0.95）。她们的雌激素受体水平较低（0.29，0.12至0.70）和孕酮受体（0.35，0.17至0.92）浓度的频率较低，并且具有较小的S相分数（0.72，0.55至0.96）比对照癌症。结论-即使在调整了较小尺寸的屏幕检测乳腺癌，其组织学和细胞学特征提示低恶性潜能。与筛查外发现的癌症相比，它们也不太可能转移到腋窝淋巴结。
Objective - To examine how breast cancers found by mammographic screening differ from those found outside screening.Design - Comparative cohort study.Setting - Turku, southwestern Finland.Patients - 126 women aged 40-74 years with breast cancer detected during the first round of mammographic screening in 1987-90 and 125 women within the same age range with breast cancer-detected outside screening during the same period.Main outcome measures - Primary tumour size, axillary nodal status, histological features, oestrogen and progesterone receptor concentrations, ploidy, and S phase fraction.Results - Compared with the controls women with cancers detected by screening had a smaller primary tumour (57 (46%) screened v 11 (10%) controls had tumours less-than-or-equal-to 11 mm in diameter, p < 0.0001), and less often had axillary nodal metastases (104 (83%) screened v 71 (57%) controls node negative, p < 0.0001). After adjustment for the smaller size of the primary tumour compared with control cancers, those cancers detected by screening were less likely to have axillary nodal metastases (odds ratio 0.44, 95% confidence interval 0.23 to 0.84), poor histological differentiation (0.20, 0.08 to 0.49), high mitotic counts (0.38, 0.15 to 0.97), tumour necrosis (0.45, 0.22 to 0.93) or to be of the ductal histological type (0.46, 0.22 to 0.95). They had low oestrogen receptor (0.29, 0.12 to 0.70) and progesterone receptor (0.35, 0.17 to 0.92) concentrations less often and had smaller S phase fractions (0.72, 0.55 to 0.96) than control cancers.Conclusions - Even after adjustment for the smaller size of screen detected breast cancers, their histological and cytometric features suggest low malignant potential. They may also be less likely to metastasise to axillary lymph nodes than cancers found outside screening.