乳腺钼靶筛查减少乳腺癌死亡率近四成

　　2020年11月23日，英国癌症研究基金会《英国癌症杂志》在线发表英国伦敦大学玛丽王后学院、伦敦大学国王学院的研究报告，调查了英格兰乳腺钼靶筛查对乳腺癌死亡风险的影响。

　　该病例对照研究选择2010～2011年死于原发乳腺癌的47～89岁女性共计8288例作为病例组，根据出生日期和筛查区域按1∶2匹配15202例女性作为对照组。

　　结果，条件逻辑回归分析表明，对自我选择偏倚进行校正后，至少筛查一次与从未参加筛查的女性相比：

  • 1990年后确诊：乳腺癌死亡率低38%（比值比：0.62，95%置信区间：0.56～0.69）

  • 2000年后确诊：乳腺癌死亡率低44%（比值比：0.56，95%置信区间：0.51～0.63）

  • 2003年后确诊：乳腺癌死亡率低47%（比值比：0.53，95%置信区间：0.47～0.59）

　　末次筛查至确诊间隔：

  • 3～6个月：乳腺癌死亡率低82%（比值比：0.18，95%置信区间：0.15～0.23）

  • 6～18个月：乳腺癌死亡率低76%（比值比：0.24，95%置信区间：0.21～0.28）

  • 18～36个月：乳腺癌死亡率低60%（比值比：0.40，95%置信区间：0.36～0.46）

  • 36～54个月：乳腺癌死亡率低38%（比值比：0.62，95%置信区间：0.53～0.73）

  • 54～72个月：乳腺癌死亡率低26%（比值比：0.74，95%置信区间：0.62～0.88）

  • 大于72个月：乳腺癌死亡率低14%（比值比：0.86，95%置信区间：0.76～0.98）

  • 0～36个月：乳腺癌死亡率低49%（比值比：0.51，95%置信区间：0.46～0.57）

　　参加筛查时年龄65～89岁，与47～59岁或60～64岁相比，乳腺癌死亡率减少程度最大、持续时间更久。

　　因此，该英格兰范围内的病例对照研究结果表明，乳腺钼靶筛查对于减少乳腺癌死亡风险仍然具有重要作用。与年轻女性相比，年龄≥65岁女性的筛查优势更强、持续时间更久。

Br J Cancer. 2020 Nov 23. Online ahead of print.

A case-control study to evaluate the impact of the breast screening programme on mortality in England.

Roberta Maroni, Nathalie J. Massat, Dharmishta Parmar, Amanda Dibden, Jack Cuzick, Peter D. Sasieni, Stephen W. Duffy.

Queen Mary University of London, London, UK; King's College London, London, UK.

BACKGROUND: Over the past 30 years since the implementation of the National Health Service Breast Screening Programme, improvements in diagnostic techniques and treatments have led to the need for an up-to-date evaluation of its benefit on risk of death from breast cancer. An initial pilot case-control study in London indicated that attending mammography screening led to a mortality reduction of 39%.

METHODS: Based on the same study protocol, an England-wide study was set up. Women aged 47-89 years who died of primary breast cancer in 2010 or 2011 were selected as cases (8288 cases). When possible, two controls were selected per case (15,202 controls) and were matched by date of birth and screening area.

RESULTS: Conditional logistic regressions showed a 38% reduction in breast cancer mortality after correcting for self-selection bias (OR 0.62, 95% CI 0.56-0.69) for women being screened at least once. Secondary analyses by age group, and time between last screen and breast cancer diagnosis were also performed.

CONCLUSIONS: According to this England-wide case-control study, mammography screening still plays an important role in lowering the risk of dying from breast cancer. Women aged 65 or over see a stronger and longer lasting benefit of screening compared to younger women.

DOI: 10.1038/s41416-020-01163-2

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