Reason for late-stage breast cancer: Absence of screening or detection, or breakdown in follow-up?
Reason for late-stage breast cancer: Absence of screening or detection, or breakdown in follow-up?
复制标题
DOI：
10.1093/jnci/djh284
复制
发表时间：
2004-10-20
影响因子：
10.3
通讯作者：
Barlow, WE
中科院分区：
文献类型：
--
作者：
Taplin, SH;Ichikawa, L;Barlow, WE
背景：乳房X光检查筛查增加了早期乳腺癌的检出率。因此，实施筛查应减少被诊断患有晚期疾病的女性比例。然而，尽管全国乳房X光检查筛查率很高，但晚期乳腺癌仍然发生，可能是因为筛查实施失败。方法：利用来自 7 个医疗保健计划（包括 150 万名 50 岁或以上女性）的数据，我们对 1995 年至 1999 年诊断的晚期（转移和/或肿瘤大小：3 cm；病例受试者，n = 1347）和早期乳腺癌（对照受试者，n = 1347）之前 3 年的图表和自动数据进行了回顾性审查。我们将诊断前 13-36 个月内的最早筛查乳房 X 光检查分类为无（未筛查）、阴性（未检测到）或阳性（随访中可能出现故障）。我们比较了每个筛查实施类别中病例和对照受试者的比例，并估计了晚期乳腺癌的可能性（比值比 [OR] 与 95% 置信区间 [CI]）。我们还评估了与晚期疾病女性缺乏筛查相关的人口特征。所有统计检验都是双面的。结果：病例组（分别为 52.1%、39.5% 和 8.4%）和对照受试者（分别为 34.4%、56.9% 和 8.8%）之间缺乏筛查、缺乏检测和潜在随访中断的分布不同（P =.03）。在所有女性中，未接受筛查的女性患晚期癌症的几率较高（OR = 2.17，95% CI = 1.84 至 2.56；P
Background: Mammography screening increases the detection of early-stage breast cancers. Therefore, implementing screening should reduce the percentage of women who are diagnosed with late-stage disease. However, despite high national mammography screening rates, late-stage breast cancers still occur, possibly because of failures in screening implementation. Methods: Using data from seven health care plans that included 1.5 million women aged 50 years or older, we conducted retrospective reviews of chart and automated data for 3 years before 1995-1999 diagnoses of late-stage (metastatic and/or tumor size :3 cm; case subjects, n = 1347) and early-stage breast cancers (control subjects, n = 1347). We categorized the earliest screening mammogram during the period 13-36 months before diagnosis as none (absence of screening), negative (absence of detection), or positive (potential breakdown in follow-up). We compared the proportion of case and control subjects in each category of screening implementation and estimated the likelihood (odds ratio [OR] with 95% confidence intervals [CIs]) of late-stage breast cancer. We also evaluated demographic characteristics associated with absence of screening in women with late-stage disease. All statistical tests were two-sided. Results: Absence of screening, absence of detection, and potential breakdown in follow-up were distributed differently among case (52.1%, 39.5%, and 8.4%, respectively) and control subjects (34.4%, 56.9%, and 8.8%, respectively) (P =.03). Among all women, the odds of having late-stage cancer were higher among women with an absence of screening (OR = 2.17, 95% CI = 1.84 to 2.56; P