Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age, or Comorbidity Score Affect Tumor Characteristics or False Positive Rates?
Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age, or Comorbidity Score Affect Tumor Characteristics or False Positive Rates?
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DOI：
10.1093/jnci/djs645
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发表时间：
2013-03-01
影响因子：
10.3
通讯作者：
Kerlikowske, Karla
中科院分区：
文献类型：
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作者：
Braithwaite, Dejana;Zhu, Weiwei;Kerlikowske, Karla
背景：由于合并症可能降低筛查的益处，老年妇女筛查性乳房x光检查的适当使用存在不确定性。我们根据筛查间隔、年龄和合并症检查了不良肿瘤特征和假阳性率的风险。方法从1999年1月至2006年12月，前瞻性地收集了2993名老年乳腺癌妇女和137949名老年非乳腺癌妇女的数据，这些妇女在乳腺癌监测联盟和医疗保险索赔之间的数据联系机构接受了乳房x光检查。在研究开始时，女性的年龄在66至89岁之间，以测量1年的既往疾病。我们使用逻辑回归分析计算晚期（IIb， III， IV）期，大（bbb20毫米）肿瘤的几率，以及通过筛查频率（1年vs 2年），年龄和合病评分计算乳房x光检查假阳性的10年累积概率。合并症评分采用Klabunde近似Charlson评分。所有统计检验均为双侧检验。结果肿瘤的不良特征在合并症、年龄或时间间隔方面无统计学差异。不论合共情况如何，每年筛查者的乳房x光检查假阳性结果的累积概率高于两年筛查者：66岁至74岁的每年筛查者中有48.0%（95%置信区间[CI] = 46.1%至49.9%）出现假阳性结果，而两年筛查者中有29.0% （95% CI = 28.1%至29.9%）出现假阳性结果。结论：无论合并症如何，66 - 89岁的女性接受两年一次的乳房x光筛查与每年一次筛查相比，其患晚期疾病的风险相似，假阳性推荐的累积风险较低。美国国立癌症研究所；2013年;105:334 - 341
Background Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity.Methods From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided.Results Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners.Conclusion Women aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity. J Natl Cancer Inst; 2013;105:334-341