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为期30年的乳腺钼靶筛查对乳腺癌发病率的影响
Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence


Archie Bleyer ... 肿瘤 • 2012.11.22
相关阅读
• 癌症的流行病学标签 • ACP新发布的指南声明:一般风险女性的乳腺癌筛查 • 早期乳腺癌患者的监测:现在是否该重新评估监测方案了 • 补充性乳腺磁共振成像检查和乳房X线筛查的风险及益处比较

摘要


背景

为减少死亡率,筛查必须在较早期和较可治愈的阶段检测出威胁生命的疾病。因此有效的癌症筛查计划不仅可以有效地增加早期癌症的检出概率,还可以降低到癌症晚期才就诊的概率。


方法

我们使用监测、流行病学及最终结果数据(Surveillance,Epidemicology,and End Results)以检测1976-2008年≥40岁的女性早期乳腺癌(导管内原位癌及局灶病变)及晚期乳腺癌(局灶及转移)的发病趋势。


结果

在美国,乳腺钼靶筛查的引入使每年检测到的早期乳腺癌的病例数增加了1倍,从每100,000名女性112例增加到了234例,即每100,000名女性中增加的绝对数为122例。相应地,患有晚期乳腺癌的女性下降了8%,即从每100,000名女性102例降低到了94例,绝对数为每100,000名女性下降了8例。假设有一种疾病负担持续存在,122名新增的被诊断出的早期癌症病例中只有8例预期进展到晚期疾病。在排除了与激素替代治疗相关的暂时性发病率过高及对40岁以下女性乳腺癌的发病率趋势进行调整之后,我们估算出,在过去的30年中,130万名美国女性中的乳腺癌被过度诊断(即在筛查中检出的肿瘤永远不会出现临床症状)。我们估计2008年70,000多名女性会有乳腺癌被过度诊断,这个数字占全部被诊断乳腺癌的31%。


结论

尽管每年早期乳腺癌病例的检出数显著增加,但乳腺钼靶筛查只是略微减低了女性因晚期癌症而就诊的比率。虽然无法确定受影响的具体女性,但是这种不平衡反映了很多病例被过度诊断,占所有新诊断乳腺癌的1/3,而且乳腺钼靶筛查充其量对乳腺癌死亡率降低只有很小的贡献。





作者信息

Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H.
From the Quality Department, St. Charles Health System, Central Oregon, and the Department of Radiation Medicine, Oregon Health and Science University, Portland (A.B.); the University of Texas Medical School at Houston, Houston (A.B.); and the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH (H.G.W.). Address reprint requests to Dr. Bleyer at 2500 NE Neff Rd., Bend, OR 97701, or at ableyer@gmail.com.

 

参考文献

1. Introduction. In: Morrison AS. Screening in chronic disease. 2nd ed. New York: Oxford University Press, 1992:3-42.

2. Welch HG, Black WC. Evaluating randomized trials of screening. J Gen Intern Med 1997;12:118-124

3. Chu KC, Kramer BS, Smart CR. Analysis of the role of cancer prevention and control measures in reducing cancer mortality. J Natl Cancer Inst 1991;83:1636-1643

4. Table 86 (page 1 of 3). Use of mammography among women 40 years of age and over, by selected characteristics: United States, selected years 1987–2008. Atlanta: Centers for Disease Control and Prevention (http://www.cdc.gov/nchs/data/hus/2010/086.pdf).

5. Use of mammography among women 40 years of age and over. Atlanta: Centers for Disease Control and Prevention (http://www.cdc.gov/nchs/health_policy/mammography.htm).

6. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence — SEER 9 Regs Research Data, Nov 2010 Sub (1973–2008) <Katrina/Rita Population Adjustment> — Linked to County Attributes — Total U.S., 1969–2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on November 2010 submission (http://seer.cancer.gov/seerstat).

7. SEER data, 1973–2009 (including July–December 2005 Hurricane Katrina impacted Louisiana cases) (http://www.seer.cancer.gov/data/seerstat/nov2011).

8. United States Census Bureau. Population estimates (http://www.census.gov/popest/data).

9. Ries LAG, Eisner MP. Cancer of the female breast. In: SEER survival monograph — cancer survival among adults: U.S. SEER Program, 1988–2001. Bethesda, MD: National Cancer Institute, 2007:105 (Table 13.6) (http://seer.cancer.gov/publications/survival/).

10. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C. Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996;275:913-918

11. Welch HG, Schwartz LM, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. Boston: Beacon Press, 2011:84-5.

12. De P, Neutel I, Olivotto I, Morrison H. Breast cancer incidence and hormone replacement therapy in Canada. J Natl Cancer Inst 2010;102:1489-1495

13. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005;353:1784-1792

14. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA 2009;302:1685-1692

15. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence — SEER 17 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973–2008 varying) — Linked to County Attributes — Total U.S., 1969–2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission (http://seer.cancer.gov/seerstat).

16. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:1687-1717

17. Kalager M, Zelen M, Langmark F, Adami H-O. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 2010;363:1203-1210

18. Autier P, Boniol M, Gavin A, Vatten LJ. Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ 2011;343:d4411-d4411

19. Zahl PH, Maehlen J, Welch HG. The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med 2008;168:2311-2316

20. Breen N, Yabroff KR, Meissner HI. What proportion of breast cancers are detected by mammography in the United States? Cancer Detect Prev 2007;31:220-224

21. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010;102:605-613

22. Zackrisson S, Andersson I, Janzon L, Manjer J, Garne JP. Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ 2006;332:689-692

23. Welch HG, Schwartz LM, Woloshin S. Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers. BMJ 2006;332:727-727

24. Kopans DB, Smith RA, Duffy SW. Mammographic screening and “overdiagnosis.” Radiology 2011;260:616-620

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