Does breast cancer screening level health inequalities out? A population-based study in an Italian region
Does breast cancer screening level health inequalities out? A population-based study in an Italian region
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DOI：
10.1093/eurpub/ckt119
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发表时间：
2014-04-01
影响因子：
4.4
通讯作者：
Fantini, Maria P.
中科院分区：
文献类型：
--
作者：
Pacelli, Barbara;Carretta, Elisa;Fantini, Maria P.
背景：尽管基于人群的筛查有可能减少乳腺癌生存率的不平等，但关于这一主题的证据仍有争议。这项研究的目的是评估在意大利埃米利亚-罗马尼亚全面实施乳房X光检查计划是否对不同教育水平的乳腺癌存活率产生影响。方法：对1997-2000年(过渡期筛查期)或2001-03年(巩固筛查期)居住在埃米利亚-罗马尼亚的所有70岁以上患有浸润性乳腺癌的妇女进行队列研究。癌症病例从区域乳腺癌登记中心检索，并随访5年。教育程度根据人口普查数据确定，并通过个人记录联系分配给癌症病例。诊断年龄分为两组(30-49岁，50-69岁：筛查目标人群)。结果：共分析9639例。在1997-2000年期间，受教育程度较低的妇女的存活率明显低于受过高等教育的妇女，无论是在年轻年龄组还是在老年年龄组。在全面实施筛查方案后，这两个年龄组的差异都缩小了，直到被邀请参加筛查的年龄组的妇女完全消失。结论：我们的研究结果表明，以人群为基础的免费有组织的乳房X光检查计划，并积极邀请所有目标人群，可以有效地减少筛查目标人群的存活率差异。
Background: Although population-based screening has the potential to reduce inequalities in breast cancer survival, evidence on this topic is controversial. The objective of this study was to evaluate whether the full implementation of a mammography screening programme in Emilia-Romagna in Italy had an impact on variations in breast cancer survival by educational level. Methods: A cohort study was performed, including all women < 70 years and residing in Emilia-Romagna who had infiltrating breast cancer registered in 1997-2000 (transitional screening period) or 2001-03 (consolidation screening period). Cancer cases were retrieved from the regional Breast Cancer Registry and followed up for 5 years. Educational level was determined from census data and allocated to cancer cases by individual record linkage. Age at diagnosis was classified into two groups (30-49, 50-69: screening target population). Results: A total of 9639 cases were analyzed. In the 1997-2000 period, low-educated women had significantly lower survival compared with high-educated women, both in the younger and in the older age-groups. After the full implementation of the screening programme, these differences decreased in both age-groups, until disappearing completely among women in the age-group invited to screening. Conclusions: Our findings suggest that a fee-free population-based organized mammography screening programme with active invitation of the whole target population could be effective in reducing differences in survival in the population targeted by the screening.