Factors contributing to mammography failure in women aged 40-49 years
Factors contributing to mammography failure in women aged 40-49 years
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DOI：
10.1093/jnci/djh269
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发表时间：
2004-10-06
影响因子：
10.3
通讯作者：
White, E
中科院分区：
文献类型：
--
作者：
Buist, DSM;Porter, PL;White, E
背景：年轻女性（40-49岁）的乳房X线摄影敏感性较低（即，在乳房X光检查阴性后发现的癌症比例高于老年妇女（2：50岁）。我们探讨了肿瘤生长速度、乳腺密度、乳腺X线摄影图像质量和乳腺癌危险因素对年轻和老年女性乳腺X线摄影灵敏度的影响。研究方法：我们研究了1988年至1993年期间被诊断为浸润性乳腺癌的576名妇女（n = 73，年龄40-49岁，n = 503，年龄50岁或以上）。间隔期癌症被定义为在阴性筛查乳房X光检查后12或24个月内和随后的乳房X光检查前诊断出的癌症。通过核分裂相计数和Ki-67阳性评估肿瘤生长率。主要结果指标是按年龄划分的间隔期癌症（1 -乳房X线摄影敏感性）女性的百分比、按年龄划分的间隔期癌症的比值比（OR）和超额比值（即，由个体协变量解释的年龄比值比的百分比）。结果如下：在12个月内，27.7%的年轻女性和13.9%的老年女性发生间隔期癌症（OR = 2.36，95%置信区间[CI] = 1.14至4.77），在24个月内，52.1%的年轻女性和24.7%的老年女性发生间隔期癌症（OR = 3.58，95% CI = 2.15至5.97）。较大的乳腺密度解释了12个月时年轻女性乳腺X线摄影灵敏度降低的67.6%，而快速肿瘤生长解释了30.6%，乳腺密度解释了24个月时年轻女性灵敏度降低的37.6%。结论：乳腺密度在很大程度上解释了12个月时乳房X光检查灵敏度的下降，而肿瘤的快速生长导致了24个月时乳房X光检查灵敏度的下降。因此，12个月与24个月的乳房X线摄影筛查间隔可能会减少更快生长的肿瘤对年轻女性乳房X线摄影灵敏度的不利影响。
Background: Younger women (40-49 years) have lower mammographic sensitivity (i.e., greater proportion of cancers detected after a negative mammogram) than older women (2:50 years). We explored the effect of tumor growth rate, breast density, mammographic image quality, and breast cancer risk factors on mammographic sensitivity in younger and older women. Methods: We studied 576 women (n = 73 aged 40-49 years and n = 503 aged 50 years or older) who were diagnosed with invasive breast cancer between 1988 and 1993. Interval cancers were defined as those diagnosed within 12 or 24 months after a negative screening mammogram and before a subsequent mammogram. Tumor growth rate was assessed by mitotic figure count and Ki-67 positivity. The main outcome measures were percentage of women with interval cancer (1 - mammographic sensitivity) by age, odds ratio (OR) of interval cancer by age, and excess odds (i.e., the percentage of the odds ratio for age that was explained by individual covariates). Results: Interval cancers occurred in 27.7% of younger women and 13.9% of older women within 12 months (OR = 2.36, 95% confidence interval [CI] = 1.14 to 4.77) and in 52.1% of younger women and 24.7% of older women within 24 months (OR = 3.58, 95% CI = 2.15 to 5.97). Greater breast density explained 67.6% of the decreased mammographic sensitivity in younger women at 12 months, whereas rapid tumor growth explained 30.6% and breast density explained 37.6% of the decreased sensitivity in younger women at 24 months. Conclusions: Breast density largely explained decreased mammographic sensitivity at 12 months, whereas rapid tumor growth contributed to decreased mammographic sensitivity at 24 months. A 12-month versus a 24-month mammography screening interval may therefore reduce the adverse impact of faster growing tumors on mammographic sensitivity in younger women.