Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study.
Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study.
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截至 2005 年，英格兰和威尔士人群乳腺筛查对乳腺癌死亡率的影响：一项个体水平队列研究。
DOI：
10.1038/bjc.2016.415
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发表时间：
2017-01-17
影响因子：
8.8
通讯作者：
Moss SM
中科院分区：
文献类型：
--
作者：
Johns LE;Coleman DA;Swerdlow AJ;Moss SM
人口乳腺癌筛查已在英国实施了25年以上，但这些计划带来的好处仍然存在争议。我们在英国进行了第一次基于个体的人群乳腺筛查队列评估，以估计NHS乳腺筛查计划（NHSBSP）对乳腺癌死亡率的影响。我们跟踪了988090名年龄在49-64岁的妇女，1991年居住在英格兰和威尔士，谁因为交错实施的NHSBSP，包括邀请的主题和一个不请自来的对照组。个人层面的乳腺癌筛查史与国家登记处的个人层面死亡率和乳腺癌发病率数据相关。通过基于发病率的死亡率分析，研究了乳腺癌死亡风险与筛查意向和第一轮就诊的关系。还调查了单轮筛查后乳腺癌的过度诊断。在调整年龄、社会经济地位和准备时间后，1991-2005年，邀请参加NHSBSP筛查与乳腺癌死亡率降低21%相关（RR=0.79，95%CI：0.73-0.84，P<0.001）。首次受邀参加者的乳腺癌死亡率比未参加者低46%（RR=0.54，95%CI：0.51- 0.57，P<0.001），在调整年龄、社会经济地位和自我选择偏差后，低32%（RR=0.68，95%CI：0.63- 0.73，P<0.001）。几乎没有证据表明过度诊断与首次筛查邀请有关。研究结果表明，1991年至2005年期间，与NHSBSP活动相关的乳腺癌死亡率大幅下降，具有统计学意义。这在公共卫生方面很重要。
Population breast screening has been implemented in the UK for over 25 years, but the size of benefit attributable to such programmes remains controversial. We have conducted the first individual-based cohort evaluation of population breast screening in the UK, to estimate the impact of the NHS breast screening programme (NHSBSP) on breast cancer mortality. We followed 988 090 women aged 49–64 years in 1991 resident in England and Wales, who because of the staggered implementation of the NHSBSP, included both invited subjects and an uninvited control group. Individual-level breast screening histories were linked to individual-level mortality and breast cancer incidence data from national registers. Risk of death from breast cancer was investigated by incidence-based mortality analyses in relation to intention to screen and first round attendance. Overdiagnosis of breast cancer following a single screening round was also investigated. Invitation to NHSBSP screening was associated with a reduction in breast cancer mortality in 1991–2005 of 21% (RR=0.79, 95% CI: 0.73–0.84, P<0·001) after adjustment for age, socioeconomic status and lead-time. Breast cancer deaths among first invitation attenders were 46% lower than among non-attenders (RR=0.54, 95% CI: 0.51–0·57, P<0.001) and 32% lower following adjustment for age, socioeconomic status and self-selection bias (RR=0.68, 95% CI: 0.63–0·73, P<0.001). There was little evidence of overdiagnosis associated with invitation to first screen. The results indicate a substantial, statistically significant reduction in breast cancer mortality between 1991 and 2005 associated with NHSBSP activity. This is important in public health terms.