THE LIFETIME RISK OF DEVELOPING BREAST-CANCER
THE LIFETIME RISK OF DEVELOPING BREAST-CANCER
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DOI：
10.1093/jnci/85.11.892
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发表时间：
1993-06-02
期刊：
影响因子：
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通讯作者：
TONG, T
中科院分区：
文献类型：
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作者：
FEUER, EJ;WUN, LM;TONG, T
背景：美国女性一生中患乳腺癌的风险通常被引用为九分之一，这是一个经常被引用的癌症统计数据。然而，许多估计使用的癌症发病率来自总人口，而不是无癌症人口，并且没有适当地考虑同一个体的多种癌症。目的：我们的目的是提供一个修订的方法来计算估计的一生中患乳腺癌的风险，并帮助解释的估计。研究方法：多重递减寿命表是通过将来自横截面数据的年龄特异性发病率和死亡率应用于一个假设的女性队列而得出的。使用了1975-1988年的发病率、死亡率和人口数据，代表了国家癌症研究所监测、流行病学和最终结果（SEER）计划的地理区域。发病率仅反映第一次乳腺原发癌;死亡率反映乳腺癌以外的其他原因。对用于计算发病率的人群分母进行了调整，以仅反映假设队列中先前未诊断为乳腺癌的女性。结果如下：我们的计算显示，使用1987-1988年SEER数据，发生浸润性乳腺癌的总体终生风险约为八分之一，尽管直到85岁，它仍然是通常引用的九分之一。结论：我们的估计值是在假设来自1987-1988年SEER数据的年龄特异性比率恒定的情况下计算的。由于发病率和死亡率随时间变化，短期（10年或20年）的条件风险估计可能更可靠。使用1975-1977年数据估计的乳腺癌终生风险（10.6分之一）上升到使用1987-1988年数据估计的风险（8分之一）的很大一部分可能归因于1）由于乳房X线检查的使用增加而早期发现流行病例和2）由于乳腺癌以外的原因导致的死亡率降低。一个常见的误解是，终生风险估计假设所有妇女都活到特定年龄（例如，85或95）。事实上，该计算假设女性在任何可能的年龄都可能死于乳腺癌以外的原因。在85岁时切断终身风险计算假设没有妇女在该年龄后患乳腺癌。虽然在1976-1977年至1987-1988年期间，罹患乳腺癌的终生风险有所上升，但死于乳腺癌的终生风险从30分之一增加到28分之一，反映出死亡率总体持平的趋势。
Background: The lifetime risk of developing breast cancer in U.S. women, often quoted as one in nine, is a commonly cited cancer statistic. However, many estimates have used cancer rates derived from total rather than the cancer-free population and have not properly accounted for multiple cancers in the same individual. Purpose: Our purpose was to provide a revised method for calculating estimates of the lifetime risk of developing breast cancer and to aid in interpretation of the estimates. Methods: A multiple decrement life table was derived by applying age-specific incidence and mortality rates from cross-sectional data to a hypothetical cohort of women. Incidence, mortality, and population data from 1975-1988 were used, representing the geographic areas of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. The incidence rates reflected only the first breast primary cancer; mortality rates reflected causes other than breast cancer. The population denominator used in calculating incidence rates was adjusted to reflect only those women without previously diagnosed breast cancers in the hypothetical cohort. Results: Our calculations showed an overall lifetime risk for developing invasive breast cancer of approximately one in eight with use of 1987-1988 SEER data, although up to age 85, it was still the commonly quoted one in nine. Conclusion: Our estimate was calculated assuming constant age-specific rates derived from 1987-1988 SEER data. Because incidence and mortality rates change over time, conditional risk estimates over the short term (10 or 20 years) may be more reliable. A large portion of the rise in the lifetime risk of breast cancer estimated using 1975-1977 data (one in 10.6) to an estimate using 1987-1988 data (one in eight) may be attributed to 1) early detection of prevalent cases due to increased use of mammographic screening and 2) lower mortality due to causes other than breast cancer. A common misperception is that the lifetime risk estimate assumes that all women live to a particular age (e.g., 85 or 95). In fact, the calculation assumes that women can die from causes other than breast cancer at any possible age. Cutting off the lifetime risk calculation at age 85 assumes that no women develop breast cancer after that age. While the lifetime risk of developing breast cancer rose over the period 1976-1977 to 1987-1988, the lifetime risk of dying of breast cancer increased from one in 30 to one in 28, reflecting generally flat mortality trends.