Recent trends in US breast cancer incidence, survival, and mortality rates
Recent trends in US breast cancer incidence, survival, and mortality rates
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DOI：
10.1093/jnci/88.21.1571
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发表时间：
1996-11-06
影响因子：
10.3
通讯作者：
Edwards, BK
中科院分区：
文献类型：
--
作者：
Chu, KC;Tarone, RE;Edwards, BK
背景：临床试验表明，使用乳房x线摄影筛查和治疗的进步可以改善乳腺癌妇女的预后。目的：我们确定了美国白人妇女乳腺癌死亡率的趋势，以及诊断时疾病程度的发病率和生存率，并考虑这些趋势是否与这种有益的医疗干预措施的广泛使用相一致。方法：我们检查了来自国家卫生统计中心的死亡率数据，以及来自国家癌症研究所监测、流行病学和最终结果计划的发病率和生存率数据，所有数据都按患者年龄分层，使用统计回归技术确定趋势斜率随时间的变化。结果：1989年至1993年，美国白人女性年龄调整后的乳腺癌死亡率下降了6.8%。从40岁到79岁，每十年死亡率趋势斜率每年显著下降约2%。这些年龄组的发病率趋势也相似：局部疾病发病率从1982年到1987年迅速上升，此后稳定或增长较慢；1987年以后，区域发病率下降；在过去的20年里，远端疾病的发病率一直保持不变。从1980年到1989年，所有年龄段的局部和区域性疾病的三年相对存活率都稳定而显著地增加，在1980年代末没有证据表明斜率增加。意义：20世纪80年代后期40岁以上妇女局部疾病诊断率的下降可能反映了20世纪80年代早期乳房x光检查的使用增加。生存率的增加，特别是区域性疾病的生存率的增加，可能反映了全身辅助治疗的改进。统计模型表明，最近乳腺癌死亡率的下降太快，不能仅仅用乳房x光检查使用的增加来解释；同样，生存率也没有相应的戏剧性增长，这意味着单独治疗。因此，有迹象表明，这两者都与最近美国乳腺癌死亡率的迅速下降有关。
Background: Clinical trials have demonstrated that use of mammographic screening and advances in therapy can improve prognosis for women with breast cancer. Purpose: We determined the trends in breast cancer mortality rates, as well as incidence and survival rates by extent of disease at diagnosis, for white women in the United States and considered whether these trends are consistent with widespread use of such beneficial medical interventions. Methods: We examined mortality data from the National Center for Health Statistics and incidence and survival data by extent of disease from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, all stratified by patient age, using statistical-regression techniques to determine changes in the slope of trends over time. Results: The age-adjusted breast cancer mortality rate for U.S. white females dropped 6.8% from 1989 through 1993. A significant decrease in the slope of the mortality trend of approximately 2% per year was observed in every decade of age from 40 to 79 years of age. Trends in incidence rates were also similar among these age groups: localized disease rates increased rapidly from 1982 through 1987 and stabilized or increased more slowly thereafter; regional disease rates decreased after 1987; and distant disease rates have remained level over the past 20 years. Three-year relative survival rates increased steadily and significantly for both localized and regional disease from 1980 through 1989 in all ages, with no evidence of an increase in slope in the late 1980s. Implications: The decrease in the diagnosis of regional disease in the late 1980s in women over the age of 40 years likely reflects the increased use of mammography earlier in the 1980s. The increase in survival rates, particularly for regional disease, likely reflects improvements in systemic adjuvant therapy, Statistical modeling indicates that the recent drop in breast cancer mortality is too rapid to be explained only by the increased use of mammography; likewise, there has been no equivalent dramatic increase in survival rates that would implicate therapy alone. Thus, indications are that both are involved in the recent rapid decline in breast cancer mortality rates in the United States.