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【JAMA】钼靶X线可用于筛查乳腺癌个人史女性早期
Nehmat Houssami, MBBS, PhD; Linn A. Abraham, MS; Diana L. Miglioretti, PhD; Edward A. Sickles, MD; Karla Kerlikowske, MD; Diana S. M. Buist, PhD, MPH; Berta M. Geller, EdD; Hyman B. Muss, MD; Les Irwig, M***h, PhD
JAMA. 2011;305(8):790-799.
http://jama.ama-assn.org/content/305/8/790.short
Context Women with a personal history of breast cancer (PHBC) are at risk of developing another breast cancer and are recommended for screening mammography. Few high-quality data exist on screening performance in PHBC women.
Objective To examine the accuracy and outcomes of mammography screening in PHBC women relative to screening of similar women without PHBC.
Design and Setting Cohort of PHBC women, mammogram matched to non-PHBC women, screened through facilities (1996-2007) affiliated with the Breast Cancer Surveillance Consortium.
Participants There were 58 870 screening mammograms in 19 078 women with a history of early-stage (in situ or stage I-II invasive) breast cancer and 58 870 matched (breast density, age group, mammography year, and registry) screening mammograms in 55 315 non-PHBC women.
Main Outcome Measures Mammography accuracy based on final assessment, cancer detection rate, interval cancer rate, and stage at diagnosis.
Results Within 1 year after screening, 655 cancers were observed in PHBC women (499 invasive, 156 in situ) and 342 cancers (285 invasive, 57 in situ) in non-PHBC women. Screening accuracy and outcomes in PHBC relative to non-PHBC women were cancer rates of 10.5 per 1000 screens (95% CI, 9.7-11.3) vs 5.8 per 1000 screens (95% CI, 5.2-6.4), cancer detection rate of 6.8 per 1000 screens (95% CI, 6.2-7.5) vs 4.4 per 1000 screens (95% CI, 3.9-5.0), interval cancer rate of 3.6 per 1000 screens (95% CI, 3.2-4.1) vs 1.4 per 1000 screens (95% CI, 1.1-1.7), sensitivity 65.4% (95% CI, 61.5%-69.0%) vs 76.5% (95% CI, 71.7%-80.7%), specificity 98.3% (95% CI, 98.2%-98.4%) vs 99.0% (95% CI, 98.9%-99.1%), abnormal mammogram results in 2.3% (95% CI, 2.2%-2.5%) vs 1.4% (95% CI, 1.3%-1.5%) (all comparisons P < .001). Screening sensitivity in PHBC women was higher for detection of in situ cancer (78.7%; 95% CI, 71.4%-84.5%) than invasive cancer (61.1%; 95% CI, 56.6%-65.4%), P < .001; lower in the initial 5 years (60.2%; 95% CI, 54.7%-65.5%) than after 5 years from first cancer (70.8%; 95% CI, 65.4%-75.6%), P = .006; and was similar for detection of ipsilateral cancer (66.3%; 95% CI, 60.3%-71.8%) and contralateral cancer (66.1%; 95% CI, 60.9%-70.9%), P = .96. Screen-detected and interval cancers in women with and without PHBC were predominantly early stage.
Conclusion Mammography screening in PHBC women detects early-stage second breast cancers but has lower sensitivity and higher interval cancer rate, despite more evaluation and higher underlying cancer rate, relative to that in non-PHBC women. Accuracy and Outcomes of Screening Mammography in Women With a Personal History of Early-Stage Breast Cancer
有早期乳腺癌个人史女性乳腺X线筛查的准确性和结果
Context Women with a personal history of breast cancer (PHBC) are at risk of developing another breast cancer and are recommended for screening mammography. Few high-quality data exist on screening performance in PHBC women.
背景：乳腺癌个人史(PHBC)女性再次患乳腺癌的风险较高，建议进行乳腺X线筛查。PHBC女性筛查效果的高水平数据目前很少。
Objective To examine the accuracy and outcomes of mammography screening in PHBC women relative to screening of similar women without PHBC.
目的：和无PHBC同类女性相比，研究PHBC女性乳腺X线筛查的准确性和结果。
Design and Setting Cohort of PHBC women, mammogram matched to non-PHBC women, screened through facilities (1996-2007) affiliated with the Breast Cancer Surveillance Consortium.
设计和条件：使用乳腺癌监测联盟的设备(1996-2007)对PHBC女性和无PHBC女性进行匹配乳腺X线筛查，根据筛查结果进行队列研究。
Participants There were 58 870 screening mammograms in 19 078 women with a history of early-stage (in situ or stage I-II invasive) breast cancer and 58 870 matched (breast density, age group, mammography year, and registry) screening mammograms in 55 315 non-PHBC women.
参与者：有早期乳腺癌（原位癌或I-II期浸润性癌）史的19 078位女性共进行58 870次筛查，与之匹配（根据乳房密度、年龄分组、X线筛查年和注册）的55 315位无PHBC女性共进行58 870次筛查。
Main Outcome Measures Mammography accuracy based on final assessment, cancer detection rate, interval cancer rate, and stage at diagnosis.
主要结果指标：根据最终评价、肿瘤检出率、间期瘤发生率和确诊时分期来评估乳腺X线筛查精确性。
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作者:admin@医学,生命科学 2011-02-25 12:02
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