BREAST-CANCER SCREENING WITH MAMMOGRAPHY - OVERVIEW OF SWEDISH RANDOMIZED TRIALS
BREAST-CANCER SCREENING WITH MAMMOGRAPHY - OVERVIEW OF SWEDISH RANDOMIZED TRIALS
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DOI：
10.1016/0140-6736(93)91067-v
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发表时间：
1993-04-17
期刊：
影响因子：
168.9
通讯作者：
LARSSON, LG
中科院分区：
文献类型：
--
作者：
NYSTROM, L;RUTQVIST, LE;LARSSON, LG
尽管筛查试验取得了令人鼓舞的结果，但乳房X线照相术在降低死亡率方面的功效仍然存在一定争议。瑞典进行了五项研究。该概述基于在马尔默、科帕伯格、奥斯特哥特兰、斯德哥尔摩和哥德堡进行的随机试验中对 282 777 名女性进行了 5-13 年的随访，结果显示，与未受邀参加乳房 X 线摄影筛查的女性相比，受邀参加乳房 X 线摄影筛查的乳腺癌死亡率显着降低了 24%（95% 置信区间 13-34%）。为了避免差异性错误分类的潜在风险，独立终点委员会在对所有患者进行盲审后对死亡原因进行了评估。致命的乳腺癌病例。无论评估的终点是什么（“乳腺癌作为潜在的死亡原因”或“死亡时存在乳腺癌”），死亡率的降低都是相似的。尽管所有年龄的相对风险的点估计值在 0.68 和 0.84 之间变化不显着，但所有研究中筛查均一致地降低了风险。据估计，自随机分组以来，受邀组 6 年内按时间计算的累积乳腺癌死亡率为每 1000 人 1.3 例，而对照组为 1.6 例。 9 年后的相应数字分别为 2.6 和 3.3，12 年后分别为 3.9 和 5.1。在随机分组中，50-69 岁的女性乳腺癌死亡率下降幅度最大（29%）。在 40-49 岁的女性中，下降了 13%，但并不显着。在这个较年轻的年龄组中，在随访的前 8 年中，受邀组和对照组的累积乳腺癌死亡率相似。 8年后，受邀女性的地位出现了变化。没有证据表明筛查对任何年龄组的乳腺癌死亡率有任何不利影响。对于 70-74 岁的女性来说，筛查似乎只产生了很小的影响。
Despite encouraging results from screening trials the efficacy of mammography in reducing mortality remains somewhat controversial. Five studies have been done in Sweden. This overview, based on 282 777 women followed for 5-13 years in randomised trials in Malmo, Kopparberg, Ostergotland, Stockholm, and Gothenburg, reveals a 24% (95% confidence interval 13-34%) significant reduction of breast cancer mortality among those invited to mammography screening compared with those not invited.To avoid the potential risk of differential misclassification causes of death were assessed by an independent end-point committee after a blinded review of all fatal breast cancer cases. The mortality reduction was similar, irrespective of the end-point used for evaluation (''breast cancer as underlying cause of death'' or ''breast cancer present at death''). There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84. The cumulative breast cancer mortality by time since randomisation was estimated at 1.3 per 1000 within 6 years in the invited group compared with 1.6 in the control group. The corresponding figures after 9 years are 2.6 and 3.3 and after 12 years 3.9 and 5.1.The largest reduction of breast cancer mortality (29%) was observed among women aged 50-69 at randomisation. Among women 40-49 there was a non-significant 13% reduction. In this younger age group cumulative breast cancer mortality was similar in the invited and control group during the first 8 years of follow-up. After 8 years there was a difference in favour of the invited women. There was no evidence of any detrimental effect of screening in terms of breast cancer mortality in any age group. Among women aged 70-74 years screening seems to have had only a marginal impact.