Mammographic Screening and Risk Factors for Breast Cancer
Mammographic Screening and Risk Factors for Breast Cancer
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DOI：
10.1093/aje/kwp304
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发表时间：
2009-12-01
影响因子：
5
通讯作者：
Colditz, Graham A.
中科院分区：
文献类型：
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作者：
Cook, Nancy R.;Rosner, Bernard A.;Colditz, Graham A.
由于与其他危险因素的关联，筛查乳房X光检查可能会扭曲乳腺癌风险模型中估计的效果。从1988年起，《护士健康研究》提供了乳房X光检查信息，在有风险因素数据的55625名女性中，截至2000年，共发生了1815起乳腺癌事件。Logistic模型适用于筛查乳房X光检查，并使用逆概率加权来调整已建立的乳腺癌风险模型中的参数。在每个两年的随访期中，大约80%的女性进行了筛查乳房X光检查，这些检查与良性乳腺疾病史、乳腺癌家族史、激素治疗、饮酒、体育活动、复合维生素和钙补充剂呈正相关，与绝经后、当前吸烟和体重指数呈负相关。医学关注的标志，包括高血压、高胆固醇和骨关节炎，是正相关的，而心血管疾病是负相关的。相反的概率加权导致良性乳腺疾病、家族病史和激素治疗的影响发生微小变化。在未调整的模型中，与当前吸烟相关的明显降低的风险在加权后被消除。因此，乳腺癌和癌症诊断的几个危险因素与乳房X光检查有关。筛查调整对这一队列中的乳腺癌预测有一些影响，特别是对激素治疗和吸烟。
Screening mammography can distort estimated effects in breast cancer risk models due to associations with other risk factors. Mammography information was available in the Nurses' Health Study from 1988, and 1,815 incident breast cancers were accrued through 2000 among 55,625 women with risk factor data. Logistic models were fit for screening mammography, and inverse probability weighting was used to adjust parameters in an established breast cancer risk model. Approximately 80% of women in each 2-year follow-up period had screening mammograms, which were positively associated with history of benign breast disease, family history of breast cancer, hormone therapy, alcohol use, physical activity, multivitamins, and calcium supplements, and negatively associated with postmenopause, current smoking, and body mass index. Markers of medical attention, including hypertension, high cholesterol, and osteoarthritis, were positively associated, while cardiovascular disease was negative. Inverse probability weighting led to small changes in effects of benign breast disease, family history, and hormone therapy. An apparent reduced risk associated with current smoking in unadjusted models was eliminated after weighting. Thus, several risk factors for breast cancer and cancer diagnosis are associated with mammographic screening. Adjustment for screening had some impact on breast cancer prediction in this cohort, especially for hormone therapy and smoking.