PERCEPTIONS OF BREAST-CANCER RISK AND SCREENING EFFECTIVENESS IN WOMEN YOUNGER THAN 50 YEARS OF AGE
PERCEPTIONS OF BREAST-CANCER RISK AND SCREENING EFFECTIVENESS IN WOMEN YOUNGER THAN 50 YEARS OF AGE
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DOI：
10.1093/jnci/87.10.720
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发表时间：
1995-05-17
期刊：
影响因子：
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通讯作者：
TOSTESON, ANA
中科院分区：
文献类型：
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作者：
BLACK, WC;NEASE, RF;TOSTESON, ANA
背景：国家癌症研究所最近改变了其方法，并将过去的摘要陈述代替了40-50岁的女性乳腺癌筛查的具体建议，使这些妇女承担了更大的决策责任。为了做出有关乳腺癌筛查的明智决定，妇女需要有关其乳腺癌风险和筛查的好处的准确信息。尽管已经提出，50岁以下的妇女高估了这种风险和利益，但尚未量化她们的估计。目的：这项研究的目的是确定女性40-50岁的年龄如何感知其乳腺癌的风险，筛查的有效性以及这些感知如何与乳腺癌发病率的流行病学研究和筛查随机临床试验得出的估计相比。方法：我们通过达特茅斯 - 希区柯克医疗中心的计算机病历鉴定了200名女性，她们40至50岁，没有乳腺癌的病史。每位妇女都被问到她的乳腺癌危险因素，并要求估计她在10年内发生乳腺癌并在筛查的情况下死亡的概率。将妇女的答案与来自Call等人的个人概率，模型，在美国发展和死亡的年龄特异性概率以及随机筛查的随机临床试验结果。结果：邮寄问卷已完成，并由200名妇女中的145名（73％）退还。受访者高估了他们在10年内死亡乳腺癌的可能性超过20倍（中值，22.3；四分位间距，11.1-74.2）。 Assuming a 10% relative risk reduction from screening, respondents overestimated the relative risk reduction by sixfold (median, 6.0; interquartile range, 5.0-7.5) and the absolute risk reduction more than 100-fold (median, 127.5; interquartile range, 47.1- 399.6）。降低绝对风险的估计值中位数为每100名妇女的乳腺癌死亡6.0；计算出的中位数估计仅为每100名女性0.04。结论：这些发现表明，许多50岁以下的妇女显着高估了她们的乳腺癌风险和筛查的有效性。含义：关于乳腺癌风险和筛查有效性的信息的平衡呈现可能会改善50岁以下女性的决策，并减轻对乳腺癌的焦虑，无论是否选择筛查。
Background: The National Cancer Institute has recently changed its approach and has substituted summary-of-evidence statements for specific recommendations for breast cancer screening in women 40-50 years of age, leaving these women with a greater share of decision-making responsibility. To make an informed decision about breast cancer screening, women need accurate information about their breast cancer risk and the benefit of screening. Although it has been suggested that women younger than 50 years of age overestimate this risk and benefit, their estimates have not been quantified. Purpose: The purpose of this study was to determine how women 40-50 years of age perceive their risk of breast cancer and the effectiveness of screening and how these perceptions compare with estimates derived from epidemiologic studies of breast cancer incidence and randomized clinical trials of screening. Methods: We mailed a questionnaire to 200 women, identified through the computerized medical records of Dartmouth-Hitchcock Medical Center, who were between 40 and 50 years of age and had no history of breast cancer. Each woman was asked about her risk factors for breast cancer and asked to estimate her probabilities of developing breast cancer and dying of it within 10 years, with and without screening. The women's answers were compared with individual probabilities derived from the Call et al, model, age-specific probabilities of developing and dying of breast cancer in the United States, and the results of randomized clinical trials of screening. Results: The mailed questionnaire was completed and returned by 145 (73%) of the 200 women. Respondents overestimated their probability of dying of breast cancer within 10 years by more than 20-fold (median, 22.3; interquartile range, 11.1-74.2). Assuming a 10% relative risk reduction from screening, respondents overestimated the relative risk reduction by sixfold (median, 6.0; interquartile range, 5.0-7.5) and the absolute risk reduction more than 100-fold (median, 127.5; interquartile range, 47.1-399.6). The median perceived estimate of absolute risk reduction was 6.0 breast cancer deaths per 100 women; the median calculated estimate was only 0.04 per 100 women. Conclusion: These findings suggest that many women younger than 50 years of age substantially overestimate their breast cancer risk and the effectiveness of screening. Implications: A balanced presentation of information about breast cancer risk and screening effectiveness may improve decision making for women younger than 50 years of age and reduce their anxiety about breast cancer, regardless of whether they choose to be screened.