Mammography use, breast cancer stage at diagnosis, and survival among older women
Mammography use, breast cancer stage at diagnosis, and survival among older women
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DOI：
10.1111/j.1532-5415.2000.tb02595.x
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发表时间：
2000-10-01
影响因子：
6.3
通讯作者：
Moskowitz, MA
中科院分区：
文献类型：
--
作者：
McCarthy, EP;Burns, RB;Moskowitz, MA
背景：65岁及以上的女性占大多数新诊断的乳腺癌和乳腺癌死亡。然而，老年妇女最不可能接受乳房X光检查，也许是因为乳房X光检查的价值在老年妇女中表现得不太好。目的：探讨老年妇女乳腺癌患者既往乳房X光检查使用情况、诊断时癌症分期和乳腺癌死亡率之间的关系。设计：回顾性队列研究，使用美国联邦医疗保险-肿瘤登记数据库。来自国家癌症研究所监测、流行病学和最终结果（SEER）计划中三个地理区域的基于人群的数据。1987年至1993年期间，居住在康涅狄格州、格鲁吉亚亚特兰大市或华盛顿西雅图-普吉特湾的67岁及以上确诊为首次原发性乳腺癌的女性。对医疗保险索赔进行了审查，并根据诊断前2年内的乳房X光检查使用情况对女性进行了分类：非使用者（没有既往乳房X光检查），常规使用者（至少两次乳房X光检查至少间隔10个月）或围诊断期使用者（仅在诊断前3个月内进行乳房X光检查）。乳腺X线摄影的应用与SEER数据相关联，以确定诊断时的分期和死亡原因。我们的主要结果变量是（1）诊断时的分期，（原位/I期）或晚期（IT期或更高），和（2）乳腺癌死亡率，从诊断到乳腺癌死亡或随访期结束（1994年12月31日）。不使用乳房X线摄影的老年妇女被诊断为乳腺癌的第二阶段或更高的频率比经常使用者（调整的比值比（OR），3.12; 95%置信区间（CI），2.74-3.58）。这种关联存在于所研究的每个年龄组中。对于所有女性（调整后的风险比（HR），3.38; 95%CI，2.65-4.32）和每个年龄组的女性，非乳腺X线摄影使用者死于乳腺癌的风险显著高于常规使用者。即使假设提前时间为1.25年，不使用乳房X光检查的人死于乳腺癌的风险仍然增加。我们的研究结果仍然显着的所有妇女和两个最年轻的年龄组（67-74岁，，75-85岁），虽然收益不再是统计学意义上的最老的妇女（85岁及以上）。结论：老年妇女定期接受乳房X光检查被诊断为疾病的早期阶段，不太可能死于他们的疾病。这些数据支持在老年妇女中定期使用乳房X光检查，并表明乳房X光检查可以降低老年妇女的乳腺癌死亡率，即使是85岁及以上的妇女。
BACKGROUND: Women age 65 years and older account for most newly diagnosed breast cancers and deaths from breast cancer. Yet, older women are least likely to undergo mammography, perhaps because mammography's value is less well demonstrated in older women.OBJECTIVE: To investigate the relationship between prior mammography use, cancer stage at diagnosis, and breast cancer mortality among older women with breast cancer.DESIGN: Retrospective cohort study using the Linked Medicare-Tumor Registry Database.SETTING: Population-based data from three geographic areas included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.PARTICIPANTS: Women aged 67 and older diagnosed with a first primary breast cancer, from 1987 to 1993, residing in Connecticut, metropolitan Atlanta, Georgia, or Seattle-Puget Sound, Washington.MEASUREMENTS: Medicare claims were reviewed and women were classified according to their mammography use during the 2 years before diagnosis: nonusers (no prior mammograms), regular users (at least two mammograms at least 10 months apart), or peri-diagnosis users (only mammogram(s) within 3 months before diagnosis). Mammography utilization was linked with SEER data to determine stage at diagnosis and cause of death. Our main outcome variables were (1) stage at diagnosis, classified as early (in situ/Stage I) or late (Stage IT or greater), and (2) breast cancer mortality, measured from diagnosis until death from breast cancer or end of the follow-up period (December 31, 1994).RESULTS: Older women who were nonusers of mammography were diagnosed with breast cancer at Stage II or greater more often than regular users (adjusted odds ratio (OR), 3.12; 95% confidence interval(CI), 2.74-3.58). This association was present within each age group studied. Nonusers of mammography were at significantly greater risk of dying from their breast cancer than regular users for all women (adjusted hazard ratio (HR), 3.38; 95% CI, 2.65-4.32) and for women within each age group. Even assuming a lead time of 1.25 years, nonusers of mammography continued to be at increased risk of dying from breast cancer. Our findings remained significant for all women and for the two youngest age groups (67-74 years,, 75-85 years), although the benefit was no longer statistically significant for the oldest women (85 years and older).CONCLUSIONS: Older women who undergo regular mammography are diagnosed with an earlier stage of disease and are less likely to die from their disease. These data support the use of regular mammography in older women and suggest that mammography can reduce breast cancer mortality in older women, even for women age 85 and older.