Performance of screening mammography among women with and without a first-degree relative with breast cancer
Performance of screening mammography among women with and without a first-degree relative with breast cancer
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DOI：
10.7326/0003-4819-133-11-200012050-00009
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发表时间：
2000-12-05
影响因子：
39.2
通讯作者：
Ballard-Barbash, R
中科院分区：
文献类型：
--
作者：
Kerlikowske, K;Carney, PA;Ballard-Barbash, R
工作背景：虽然建议有乳腺癌家族史的妇女开始筛查乳房X线摄影的年龄比平均风险妇女要小，但很少有研究评价乳房X线摄影在这一群体中的表现。目的：比较筛查乳房X线摄影在有一级乳腺癌家族史的妇女和年龄相近但没有这种病史的妇女中的表现。设计：横断面。设置：在加州（n = 1）、新罕布什尔州（n = 1）、新墨西哥州（n = 1）、佛蒙特州（n = 1）、华盛顿州（n = 2）和科罗拉多州（n = 1）的乳房X线摄影登记处。以及通过与病理学数据库、监测、流行病学和最终结果计划或州肿瘤登记处的链接确定的任何浸润性癌症或导管原位癌。每1000次检查的癌症病例数随着年龄的增长而增加，有乳腺癌家族史的女性比没有家族史的女性更高（30至39岁为3.2与1.6，40至49岁为4.7与2.7，50至59岁为6.6与4.6，60至69岁为9.3与6.9）。乳腺X线摄影的敏感性随年龄增长而显著增加（P = 0.001 [趋势卡方检验]）有家族史和无家族史的女性（30至39岁年龄组为63.2% [95% CI，41.5%至84.8%] vs. 69.5% [Ct，57.7%至81.2%]，70.2% [CI，61.0%至79.5%] vs. 77.5% [CI，年龄40 - 49岁为73.3%-81.8%]，年龄50 - 59岁为81.3% [CI，73.3%-89.3%] vs. 80.2% [CI，76.5%-83.9%]，年龄50 - 59岁为83.8% [CI，76.8%-90.9%] vs. 87.7% [Cf，84.8%至90.7%]（60至69岁）。无论家族史如何，每十年的敏感性都是相似的。乳腺X线摄影的阳性预测值在有家族史的女性中高于无家族史的女性（3.7%对2.9%; P = 0.001）。结论：有乳腺癌病史的一级亲属的女性的癌症检出率与无乳腺癌病史的10岁以上女性的癌症检出率相似。筛查性乳腺X线摄影的灵敏度主要受年龄的影响。
Background: Although it is recommended that women with a family history of breast cancer begin screening mammography at a younger age than average-risk women, few studies have evaluated the performance of mammography in this group.Objective: To compare the performance of screening mammography in women with a first-degree family history of breast cancer and women of similar age without such history.Design: Cross-sectional.Setting: Mammography registries in California (n = 1) New Hampshire (n = 1), New Mexico (n = 1), Vermont (n = 1) Washington State (n = 2), and Colorado (n = 1).Measurements: Risk factors for breast cancer; results of first screening examination captured for a woman by a registry; and any invasive cancer or ductal carcinoma in situ identified by linkage to a pathology database, the Surveillance, Epidemiology, and End Results program, or a state tumor registry.Results: The number of cancer cases per 1000 examinations increased with age and was higher in women with a family history of breast cancer than in those without (3.2 vs. 1.6 for ages 30 to 39 years, 4.7 vs. 2.7 for ages 40 to 49 years, 6.6 vs. 4.6 for ages 50 to 59 years, and 9.3 vs. 6.9 for ages 60 to 69 years). The sensitivity of mammography increased significantly with age (P = 0.001 [chi-square test for trend]) in women with a family history and in those without (63.2% [95% CI, 41.5% to 84.8%] vs. 69.5% [Ct, 57.7% to 81.2%] for ages 30 to 39 years, 70.2% [CI, 61.0% to 79.5%] vs. 77.5% [CI, 73.3% to 81.8%] for ages 40 to 49 years, 81.3% [CI, 73.3% to 89.3%] vs. 80.2% [CI, 76.5% to 83.9%] for ages 50 to 59 years, and 83.8% [CI, 76.8% to 90.9%] vs. 87.7% [Cf, 84.8% to 90.7%] for ages 60 to 69 years). Sensitivity was similar for each decade of age regardless of family history. The positive predictive value of mammography was higher in women with a family history than in those without (3.7% vs. 2.9%; P = 0.001).Conclusions: Cancer detection rates in women who had a first-degree relative with a history of breast cancer were similar to those in women a decade older without such a history. The sensitivity of screening mammography was influenced primarily by age.