Efficacy of breast cancer screening in the community according to risk level
Efficacy of breast cancer screening in the community according to risk level
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DOI：
10.1093/jnci/dji183
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发表时间：
2005-07-20
影响因子：
10.3
通讯作者：
Fletcher, SW
中科院分区：
文献类型：
--
作者：
Elmore, JG;Reisch, LM;Fletcher, SW
乳腺癌筛查在社区中的效果可能与随机试验的结果有所不同，目前还没有关于不同乳腺癌风险水平妇女的效果的数据。方法：我们在华盛顿州、俄勒冈州、加利福尼亚州、马萨诸塞州和明尼苏达州参加6个健康计划的妇女中进行了配对病例对照研究。我们在两个年龄组（40-49岁和50-65岁）和两个乳腺癌风险水平（平均和增加风险）的妇女中检查了乳房x光检查和/或临床乳房检查的筛查效果。从1983年1月1日至1998年12月31日期间死于乳腺癌的女性（N = 1351；病例受试者）在年龄和风险水平上与对照受试者（N = 2501）相匹配。风险增加的定义为在索引日期之前有乳腺癌家族史或医疗记录中记录的乳腺活检（定义为病例受试者首次怀疑乳房异常的日期，与匹配的对照组受试者使用相同的日期）。筛选、风险状况和其他变量的数据从医疗记录中提取。使用条件逻辑回归来检验乳腺癌死亡率与接受筛查之间的关系。所有统计检验均为双侧检验。结果：年轻女性乳腺癌死亡率与在指标日期前3年内接受筛查之间存在小的、无统计学意义的关联[优势比(OR) = 0.92；95%可信区间（CI） 0.76 ~ 1.13)和老年妇女（OR = 0.87; 95% Cl = 0.68 ~ 1.12）。增高风险组（OR = 0.74; 95% Cl = 0.50 ~ 1.03）与平均风险组（OR = 0.96; 95% Cl = 0.80 ~ 1.14）的相关性较强，但差异无统计学意义（P = 0.17）。结论：在这项以社区为基础的研究中，筛查史与乳腺癌死亡率无关。然而，这项研究的潜在局限性要求对这些发现进行谨慎的解释。
The efficacy of breast cancer screening in the community may differ from that suggested by the results of randomized trials, and no data have been available on efficacy among women who have different levels of breast cancer risk. Methods: We conducted a matched case-control study among women enrolled in six health plans in Washington, Oregon, California, Massachusetts, and Minnesota. We examined the efficacy of screening by mammography and/or clinical breast examination among women in two age cohorts (40-49 years and 50-65 years) and in two breast cancer risk levels (average and increased risk). Women who died from breast cancer from January 1, 1983, through December 31, 1998, (N = 1351; case subjects) were matched to control subjects (N = 2501) on age and risk level. Increased risk was defined as a family history of breast cancer or a breast biopsy noted in the medical records before the index date (defined as date of first suspicion of breast abnormalities in case subjects, with the same date used for matched control subjects). Data on screening, risk status, and other variables were abstracted from medical records. Conditional logistic regression was used to examine the association between breast cancer mortality and receipt of screening. All statistical tests were two-sided. Results: There were small, non-statistically significant associations between breast cancer mortality and receipt of screening during the 3 years prior to the index date for both the younger women [odds ratio (OR) = 0.92; 95% confidence interval (CI) 0.76 to 1.13] and the older women (OR = 0.87; 95% Cl 0.68 to 1.12). The association among women at increased risk (OR = 0.74; 95% Cl = 0.50 to 1.03) was stronger than that among women at average risk (OR = 0.96; 95% Cl = 0.80 to 1.14), but the difference was not statistically significant (P = .17). Conclusions: In this community-based study, screening history was not associated with breast cancer mortality. However, potential limitations of this study argue for a cautious interpretation of these findings.