乳腺癌筛查间隔:对诊断时晚期疾病发生率和总生存率的影响。

IF 42.1 1区 医学 Q1 ONCOLOGY Journal of Clinical Oncology Pub Date : 2024-11-10 Epub Date: 2024-08-21 DOI:10.1200/JCO.24.00285
Margarita L Zuley, Andriy I Bandos, Stephen W Duffy, Durwin Logue, Rohit Bhargava, Priscilla F McAuliffe, Adam M Brufsky, Robert M Nishikawa
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引用次数: 0

摘要

目的:乳腺放射摄影筛查对乳腺癌预后的影响仍存在争议。我们利用真实世界的机构研究数据集市评估了不同筛查间隔期的晚期癌症发生率和总生存率(OS):方法:从我们的机构研究乳腺数据集市中识别出 2004 年至 2019 年期间既有新乳腺癌诊断癌症登记记录又有诊断前筛查史的患者。确定诊断前两次乳房 X 光筛查的时间间隔和癌症诊断时间。如果筛查时间间隔≤15个月,则视为每年一次;如果筛查时间间隔大于15个月且≤27个月,则视为每两年一次;如果筛查时间间隔大于27个月,则视为间歇性筛查;如果只知道一次诊断前筛查,则视为基线筛查。主要终点是晚期癌症(TNM IIB期或更差),次要终点是OS。筛查间隔与晚期癌症的关系采用多变量逻辑回归进行分析,并对诊断前特征进行了调整。生存分析采用比例危险回归。利用从统一固定时间点开始的存活率分析潜在的提前期:共有 8,145 名乳腺癌患者在该时间段内进行了诊断前乳腺 X 光筛查。晚期癌症的诊断比例随着筛查间隔的延长而显著增加,每年、每两年和间歇性筛查组的晚期比例分别为 9%、14% 和 19%(P < .001)。无论年龄、种族和绝经状况如何,这一趋势都持续存在。与每年筛查组相比,两年筛查组和间歇筛查组的OS要差得多,相对危险度分别为1.42(95% CI,1.11至1.82)和2.69(95% CI,2.11至3.43),调整潜在准备时间后分别为1.39(95% CI,1.08至1.78)和2.01(95% CI,1.58至2.55):在不同的临床和人口亚群中,每年进行乳腺X线照相筛查可降低晚期癌症风险,改善患者的生存期。我们的研究表明,40 岁及以上的女性每年接受筛查是有益的。
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Breast Cancer Screening Interval: Effect on Rate of Late-Stage Disease at Diagnosis and Overall Survival.

Purpose: Controversy continues regarding the effect of screening mammography on breast cancer outcomes. We evaluated late-stage cancer rate and overall survival (OS) for different screening intervals using a real-world institutional research data mart.

Methods: Patients having both a cancer registry record of new breast cancer diagnosis and prediagnosis screening history between 2004 and 2019 were identified from our institutional research breast data mart. Time interval between the two screening mammograms immediately preceding diagnosis and the time to cancer diagnosis were determined. Screening interval was deemed annual if ≤15 months, biennial if >15 and ≤27 months, intermittent if >27 months, and baseline if only one prediagnosis screen was known. The primary end point was late-stage cancer (TNM stage IIB or worse), and the secondary end point was OS. The association of screening interval and late-stage cancer was analyzed using multivariable logistic regression adjusting for prediagnosis characteristics. Proportional hazards regression was used for survival analysis. Potential lead time was analyzed using survival from a uniform fixed time point.

Results: In total, 8,145 patients with breast cancer had prediagnosis screening mammography in the timeframe. The percentage of late-stage cancers diagnosed increased significantly with screening interval with 9%, 14%, and 19% late stages for annual, biennial, and intermittent groups (P < .001), respectively. The trend persisted regardless of age, race, and menopausal status. Biennial and intermittent groups had substantially worse OS than the annual screened group, with relative hazards of 1.42 (95% CI, 1.11 to 1.82) and 2.69 (95% CI, 2.11 to 3.43), respectively, and 1.39 (95% CI, 1.08 to 1.78) and 2.01 (95% CI, 1.58 to 2.55) after adjustment for potential lead time.

Conclusion: Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.

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来源期刊
Journal of Clinical Oncology
Journal of Clinical Oncology 医学-肿瘤学
CiteScore
41.20
自引率
2.20%
发文量
8215
审稿时长
2 months
期刊介绍: The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.
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