CASE-CONTROL STUDY OF MAMMOGRAPHY

40~49岁和70岁女性乳房X线筛查的效果 没有在随机对照试验中得到证实，仍然是 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式 目前计划和病例对照研究提供了一种选择，以获得 关于及时筛查乳房X光检查效果的新信息 举止。我们建议在40-87岁的女性中进行这样的研究 北加州的大型预付费健康计划。比任何人都大 到目前为止发表的这项研究将包括大约1500名患有 致命的乳腺癌，在1980-1994年间被诊断出来，他们是 健康计划，并可能接触乳房X光检查至少3年 在他们确诊之前。接触筛查乳房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进行比较 在确诊前的特定时期内，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 考虑到可检测到的乳腺癌临床前阶段的年龄。 此外，我们还将评估乳房X光检查的效果 大约有300名黑人女性和118名亚洲女性。的重要问题 混淆的和健康的筛查偏见将通过比较解决 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的数量和 在评估间隔之前进行的筛查乳房X光检查的次数。 乳腺癌死亡率的估计相对风险(OR)将为 用多元Logistic回归确定配对集合和疗效 将等于1-OR。研究团队在进行这些方面经验丰富。 研究的类型和环境提供了定义的和可访问的 人群中，高水平接触乳房X光检查，有能力联系 计算机存储的数据集，以及集中提供的医疗 唱片。

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.