CASE-CONTROL STUDY OF MAMMOGRAPHY

40-49岁和>70岁妇女筛查性乳腺X线摄影的有效性 尚未在随机对照试验中得到证实， 这是一个有争议的问题，尽管它对公共卫生具有高度的重要性。 没有新的随机对照试验，这是评估这个问题的最佳方法， 目前计划的病例对照研究提供了一种选择， 及时提供有关筛查性乳房X光检查有效性的新信息， 方式 我们建议在40-87岁的女性中进行这样的研究， 北方加州的大型预付医疗计划。 远远大于任何 迄今为止，这项研究将包括估计1500名妇女， 1980年至1994年诊断出患有致命乳腺癌， 健康计划和可能暴露于乳房X光检查至少3年 在诊断之前。 暴露于筛查性乳房X光检查，而不是 诊断性乳房X光检查，将由医疗审计确定，并比较 在诊断前的特定时期内，病例和对照之间的差异。 筛查将在40-49岁、50-69岁和70-87岁的女性中进行评估， 年龄考虑到乳腺癌的可检测的临床前阶段。 此外，我们还将评估乳房X光检查在以下患者中的疗效： 大约300名黑人和118名亚裔女性。 的重要问题 混杂和健康筛选偏倚将通过比较 诊断前从病历中获得的危险因素数据 并通过控制以前的健康检查次数和 在评估间隔前进行的筛查乳房X线检查次数。 乳腺癌死亡率的估计相对风险（OR）为 通过匹配集和疗效的多元logistic回归确定 将等于1 - OR。 研究小组在进行这些方面经验丰富， 类型的研究和设置提供了一个定义和访问 人口，高水平的乳房X光检查， 计算机存储的数据集，以及医疗服务的集中可用性 记录

The effectiveness of screening mammography for women aged 40-49 and >70 has not been demonstrated in randomized controlled trials and remains a controversial issue despite its high degree of public health importance. No new RCTs, which is the best way to evaluate this question, are currently planned and case-control studies present an option for obtaining new information on the efficacy of screening mammography in a timely manner. We propose to perform such a study among women aged 40-87 in a large pre-paid health plan in Northern California. Far larger than any published to date, this study will include an estimated 1500 women with fatal breast cancer, diagnosed from 1980-1994, who were members of the health plan and potentially exposed to mammography for at least 3 years before their diagnosis. Exposure to screening mammography, as opposed to diagnostic mammography, will be determined by medical audits and compared between cases and controls for specified periods up to the diagnosis. Screening will be evaluated among women 40-49, 50-69, and 70-87 years of age taking into account the detectable preclinical phase of breast cancer. In addition we will evaluate the efficacy of mammography among approximately 300 black and 118 Asian women. The important problems of confounding and healthy screening biases will be addressed by comparing data on risk factors obtained from the medical records before diagnosis and by controlling for the number of previous health checkups and for the number of screening mammograms done prior to an interval being assessed. The estimated relative risk (OR) of breast cancer mortality will be determined by multiple logistic regression for matched sets and efficacy will equal 1 - OR. The research team is experienced in conducting these types of studies and the setting offers a defined and accessible population, a high level of exposure to mammography, an ability to link computer-stored datasets, and the centralized availability of medical records.