2016-2018年湖南省农村妇女乳腺癌筛查结果分析

背景与目的:乳腺癌是妇女常见的恶性肿瘤之一,发病呈上升趋势,病死率居女性各类恶性肿瘤的病死率之首,乳腺癌疾病负担不断上升,早期检测非常重要,但是我国乳腺癌筛查工作起步较晚,对各种筛查方法的检测效果报道不一.因此,本研究利用湖南省农村35～64岁适龄妇女"两癌"免费筛查项目数据,旨在分析我省农村妇女乳腺癌筛查效果.方法:...     

中国女性乳腺癌群体筛查与机会性筛查的比较研究

目的比较乳腺癌群体筛查和机会性筛查两种模式的人群特点、筛查阳性率、乳腺癌检出率、早期乳腺癌比例及筛查费用。方法本研究为前瞻性多中心队列研究,研究时间为2014年1月1日至2016年12月31日。分别入组群体筛查和机会性筛查受试者,填写调查问卷表,并进行每年1次乳腺体检及乳腺超声检查,共完成3轮筛查,采用χ²检验、Fisher确切概率法和Wilcoxon秩和检验比较两组人群的特点及筛查结果。结果共入组受试者20080人。群体筛查组完成3轮筛查的人数分别为9434人(100%)、8111人(85.98%)和3940人(41.76%);机会性筛查组分别为10646人(100%)、6209人(58.32%)和2988人(28.07%)。机会性筛查组中产后哺乳时间<3个月(1275/9796比1061/8860,χ²=4.597,P=0.032)、未生育(850/10646比574/9434,χ²=27.400,P<0.01)、有流产史(6384/10646比5062/9434,χ²=81.232,P<0.01)、绝经后(2776/10646比2217/9434,χ²=17.757,P<0.01)、口服避孕药>6个月(171/10646比77/9434,χ²=25.593,P<0.01)及一级亲属乳腺癌阳性家族史(464/10646比236/9434,χ²=51.257,P<0.01)比例高于群体筛查组。机会性筛查组筛查阳性率(514/10646比128/9434,χ²=194.736,P<0.01)、乳腺癌检出率(158/10646比13/9434,χ²=107.374,P<0.01)和活检阳性率(158/452比13/87,χ²=13.491,P<0.01)高于群体筛查组。群体筛查组早期乳腺癌(0期和Ⅰ期)比例高于机会性筛查组(10/12比66/141,χ²=5.902,P=0.015)。群体筛查组发现每1例乳腺癌的平均费用为215038元,是机会性筛查组15799元的13.6倍。机会性筛查组基层医院的活检阳性率低于大型医院(79/267比79/185,χ²=8.267,P=0.004),而群体筛查组两者无明显差异(6/37比7/50,χ²=0.082,P=0.774)。结论乳腺癌筛查可以早期发现乳腺癌。机会性筛查具有受试者乳腺癌高危因素比例高、筛查阳性率高、乳腺癌检出率高、活检阳性率高、筛查费用低的特点。但是,机会性筛查的早期乳腺癌比例低于群体筛查,基层医院开展机会性筛查时活检阳性率较低。两种筛查模式各有优势,需要有机结合,取长补短。     

国外对于乳腺癌钼靶筛查的不同评价

乳腺癌钼靶筛查在欧美国家开展较早,笔者将近年国外对钼靶筛查的评价标准、意义等问题的再认识进行综述。     

武汉市城市社区居民结直肠癌筛查初步结果分析

目的探讨结直肠癌筛查方案在城市中应用存在的问题并提出建议。方法以全国结直肠癌早诊早治项目规定的结直肠癌筛查技术方案为依据,对武汉市江岸区2个城市社区40～74岁的当地居民开展结直肠癌筛查。以危险因素数量化评估问卷调查及免疫法FOB检查作为初筛,初筛阳性者进行结肠镜检查作为复筛。结果应参加筛查的26961人中,实际参加筛查6191人,初筛顺应率为22.9%,阳性人数为1559人,阳性率25.2%;实际参加复筛人数为1000人,复筛顺应率为64.1%;发现结直肠癌6例,结直肠息肉及腺瘤187例,结直肠炎63例,结直肠黑斑病6例;6例结直肠癌均行手术治疗,其中DukesA期4例,DukesB期2例。结论结直肠癌筛查方案能够有效的从无症状人群中发现早期结直肠癌和癌前病变;通过初筛可有效的减少复筛人数,避免了不必要的结肠镜检查,降低了筛查成本;城市社区居民结直肠癌筛查的顺应率明显低于农村。     

长春市15 192例男性前列腺癌集团筛查结果分析

目的通过对中国长春市和日本名取市集团筛查前列腺癌对比性研究,揭示两国人群中前列腺癌病理学特征。方法长春市15 192名和名取市4 444名人群中50岁以上的男性应用血清PSA检测进行前列腺癌的集团筛查,对血清PSA含量>4.0ng/ml阳性候选者行前列腺穿刺活检。结果(1)长春市人群中筛状腺癌为42.4%(42/99),名取市为18.3%(21/115)(P<0.01);长春市人群中小腺泡腺癌为29.3%(29/99),名取市为73.9%(85/115)(P<0.01);(2)长春市人群中低分化腺癌为64.7%(64/99),名取市24.3%(28/ 115)(P<0.01),长春市中分化腺癌为33.3%(33/99),名取市为72.2%(83/115)(P<0.01);(3)长春市人群中43.4%(43/99)的腺癌出现神经周围浸润,而名取市为7.0%(8/115)(P<0.01);长春市人群中11.1%(11/99)腺癌出现被膜浸润,而名取市未发现被膜浸润(P<0.01)。结论(1)长春市人群中前列腺腺癌较名取市以低分化癌为主;(2)长春市人群中进展期前列腺癌较名取市人群中多。     

2013年北京市通州区乳腺疾病筛查结果分析

目的了解本区妇女的自我保健意识及各种乳腺病变尤其是乳腺癌的患病情况,为今后的妇女病防治重点及周期性筛查方案提供理论依据。方法采用统一诊断标准,统一问卷。乳腺检查以手诊、超声检查、钼靶X线检查及病理检查相结合的方法。结果查出乳腺增生13390例;乳腺纤维腺瘤551例;其他乳腺良性疾病1878例;乳腺癌癌前病变3例;乳腺癌4例;在研究职业与乳腺疾病的关系中发现,企事业单位职工患乳腺疾病的比例最高,其他依次为公务员和老师,其他以及农民。结论通过开展乳腺癌普查工作,普及了乳腺癌知识,提高了广大妇女自我保健意识。     

45岁以上女性乳腺癌数字化X线成像筛查结果的分析

女性乳腺癌可通过人群筛查获得早期诊断，从而提高患者生存质量并明显降低死亡率。筛查的主要手段是乳腺检查及乳腺X线成像检查。在欧美定期的乳腺X线成像筛查已获得了广泛的肯定，国内近年也开始重视对乳腺癌的筛查工作。本研究报道了一个特定小样本人群的乳腺癌X线筛查结果，希望对国内开展这方面工作提供一些初步的经验。     

高频B超在中国妇女致密型乳腺的乳腺癌筛查中的应用

目的：探讨超声检查及定位在中国妇女致密型乳腺发生的早期乳腺癌筛查中的作用。方法：对2002年2月—2006年4月来湘雅医院乳腺科门诊就诊及体检中心健康检查的5万余名女性行乳腺高频超声检查，筛查出乳腺肿块4 000余例，其中经手术病理证实的致密型乳腺患者乳腺癌142例（肿块最大横径均≤2cm），将患者的超声检查与钼靶片结果资料进行分析对比。结果：在142例致密型乳腺的乳腺癌患者中，超声发现微小钙化47例（33.10％），敏感性达74.60％，准确率为88.73％;钼靶发现泥沙样钙化38例（26.76％），敏感性60.32％，准确率为82.39％。钙化灶的检出率为44.37％。其中超声发现微小肿块110例（77.46％），敏感性88.71％，准确率为90.14％;钼靶片发现100例（70.42％），敏感性80.65％，准确率为83.10％。12例临床上未扪及肿块患者均在超声定位下准确地切除病灶。结论：（1）高频超声检查在中国妇女致密型乳腺的乳腺癌筛查中检出小肿块及恶性钙化的敏感性以及准确率要高于钼靶片检查。（2）高频超声检查可作为年青妇女、致密型乳腺以及扁平型乳腺早期乳腺癌筛查的有效方法之一，它不仅提高早期乳腺癌的诊断率也提高了保乳率，值得推广使用。     

乳腺高频钼靶X线联合乳管镜筛查乳腺癌

目的 了解广东省佛山市顺德区城市妇女乳腺高频钼靶X线联合乳管镜筛查乳腺癌的情况.方法 2011年3月-2013年1月采用临床乳腺检查初筛,以及乳腺高频钼靶X线检查联合选择性乳管镜检查,对广东省佛山市顺德区3 600例40岁以上妇女进行了乳腺癌筛查.结果 3 600例妇女共检出乳腺癌10例,检出率为278/10万(10/3600).乳腺临床检查中发现乳腺异常1 313例、乳腺肿块142例、乳头溢液行乳管镜检查100例;乳腺高频钼靶X线检查4级及以上者72例,总共占筛查人群的45.19％(1 627/3 600).结论 通过乳管镜联合乳腺高频钼靶X线片在正常人群中进行乳腺癌筛查,有助于发现早期乳腺癌,为临床早期治疗提供依据.     

广州市乳腺癌机会性筛查与团体性筛查结果的比较

目的比较广州市地区机会性筛查与团体性筛查的人群分布,探索影响检查结果阳性的因素。方法机会性筛查的研究对象选取2015年1月~2015年12月来中山大学孙逸仙纪念医院乳腺肿瘤中心就诊的病人,且既往未诊断过乳腺疾病。团体性筛查的研究对象选取同年1月~12月参加我院乳腺肿瘤医学部诊断科开展的广州市女职工(含退休)乳腺癌筛查项目的女性。采用调查问卷的形式,对研究对象采用自填式问卷的方式进行调查。比较两组筛查人群的基本特征,探索影响检查结果阳性的因素。结果研究显示机会性筛查组年龄较团体性筛查组小,初潮年龄较大,哺乳时间较长,初产年龄较年轻,流产次数较多,生育次数也较多。机会性筛查组影像学检查阳性率、活检率均高于团体性筛查组。影响筛查检查阳性结果的独立危险因素是机会性筛查的方式和初潮年龄大于12岁。团体性筛查组确诊的乳腺癌中早期的比例更高。结论团体性筛查组人群分布特征与机会性筛查组不同,检查结果阳性率更高,活检率低于机会性筛查组,但是活检阳性率较高。     

乳腺癌筛查中高频B超检查的价值

目的：探讨乳腺癌筛查中应用高频B超的价值。 方法：对桂林市13 535例（包括1 1167例城区妇女和2 368例农村妇女）35~69岁妇女进行以临床乳腺检查→选择性高频B超→选择性乳腺钼靶（MG）为模式的乳腺癌筛查。 结果：最终以病理诊断为标准,共检出乳腺癌（恶性肿瘤）8例,检出率为0.591‰（8/13 535）。其中,高频B超阳性8例,敏感性为100%;MG阳性7例,假阴性1例,敏感性为87.5%。 结论：高频B超在乳腺癌筛查中呈现出较高的敏感性,且具有无创,价格低廉,适应范围广,操作方便等优势。     

Outcomes among women younger than age 40 in a state breast cancer screening program

BACKGROUND: The value of entering women younger than age 40 in breast cancer screening programs (SPs) remains unclear. METHODS: Data from the Oregon Breast and Cervical Cancer Program (BCCP) for the period December 31, 2000 through July 1, 2003 were reviewed with a focus on women 39 years of age or younger. Information on cancers detected in this group was extracted from The Oregon State Cancer Registry. RESULTS: Of the 13,636 women screened, 797 (5.8%) were younger than 40 (mean age 31.9 years). A total of 20.6% of the women were asymptomatic and therefore represented true incidence screening, while 79.4% were referred to the program for symptoms (prevalence screen). A total of 125 biopsies were done out of 797 women, which yielded 5 cancers. All 5 of these patients were symptomatic at presentation and had a negative family history. CONCLUSIONS: There are as yet no data in our state breast cancer SP to support screening of asymptomatic women younger than 40.     

Impact of the age expansion of breast screening on screening uptake and screening outcomes among older women in BreastScreen western

ObjectivesTo assess the impact of age expansion of screening (EOS) of the target age group from 50 to 69 to 50–74 in Australia, which began mid-2013, by examining screening uptake and outcomes of older women, and by identifying factors associated with continuing screening after reaching the age of 75 years.MethodsRetrospective study using data from women aged 65+ who attended BreastScreen Western Australia between 2010 and 2017 for free mammograms. Screening uptake and screening outcomes were calculated for the periods before (2010–2012) and after (2015–2017) the age EOS to women aged 70–74. Logistic regression was used to identify variables associated with continuing screening after reaching age 75 years, while controlling for possible confounding variables.ResultsAge EOS increased screening uptake amongst women aged 70–74 b y 36% and amongst women ≥75 years by 3% while screening uptake in women aged 65-69 decreased by 3%. Rate of invasive screened-detected cancers significantly decreased among women aged 70–74 from 11.4/1000 screens before to 8.1/1000 screens after age EOS. Likelihood of continuing screening into age ≥75 years was higher in women who had a personal history or a family history of breast cancer, or used hormone replacement therapy within six months of screening. Women who were born outside Australia were less likely to continue screening after reaching age 75 years.ConclusionsOur study found that age EOS to women aged 70–74 was effective in increasing screening uptake in this age-group but was accompanied by a moderate increase in screening uptake amongst women ≥75 years via self-referral for whom potential benefit of screening may be limited.     

Breast cancer in a county hospital population: Impact of breast screening on stage of presentation

Background: Indigent patients in a county hospital setting typically present with breast cancer at a later stage than do patients in the private sector. In the early 1980s, 50% of all breast cancers diagnosed in our county hospital were stages III and IV. This contrasted markedly with the findings of an American College of Surgeons study, which showed <15% of breast cancers diagnosed as stages III and IV. Methods: Recognizing this disparity, we instituted a breast screening project in the county teaching hospital targeted at women who routinely received medical care in the county hospital clinics. Between 1985 and 1992, 14,567 mammograms were performed. Results: Two hundred eighty-nine breast biopsies were performed and 76 cancers were identified (26%). Ninety-five patients advised to have surgical consultation for biopsy declined further evaluation. The stage distribution of cancers diagnosed was as follows: stage 0, 20%; stage I, 43%; stage II, 28%; stage III, 8%; and stage IV, 1%. This compares favorably with National Cancer Data Base statistics for 1988. In contrast, symptomatic nonscreened patients diagnosed at the county hospital in 1992 presented at a significantly more advanced stage: stage 0, 1%; stage I, 14%; stage II, 45%; stage III, 26%; and stage IV, 13%. Conclusions: Mammographic screening has lowered the stage of cancers diagnosed in the screened indigent population. However, a significant percentage of patients are presenting to our hospital with stage III and IV disease. Problems identified in the screening project included noncompliance with recommendations for follow-up of abnormal studies and noncompliance with appointments. In order to broaden the impact of our breast screening project, we have instituted outreach programs with community-based clinics and the American Cancer Society.The results of this study were presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Breast cancer screening halves the risk of breast cancer death: A case-referent study

Large-scale epidemiologic studies have consistently demonstrated the effectiveness of mammographic screening programs, however the benefits are still subject to debate. We estimated the effect of the Dutch screening program on breast cancer mortality. In a large multi-region case-referent study, we identified all breast cancer deaths in 2004 and 2005 in women aged 50–75 who had been invited for screening (cases). Cases were individually matched to referents from the population invited to screening. Conditional logistic regression was used to estimate the odds ratio (OR) of breast cancer death according to individual screening history. The OR was adjusted for self-selection bias using regional correction factors for the difference in baseline risk for breast cancer death between screened and unscreened women. A total of 1233 cases and 2090 referents were included in this study. We found a 58% reduction in breast cancer mortality in screened versus unscreened women (adjusted OR = 0.42, 95% CI 0.33–0.53). Screening, i.e. early detection and treatment, has resulted in a substantial reduction in breast cancer mortality, indicating that the Dutch breast cancer screening program is highly effective.     

Breast ultrasound in 22,131 asymptomatic women with negative mammography

PurposeTo evaluate increment cancer detection rate generated by ultrasound (US).Materials and methodsUS only detected cancers were assessed for 22,131 self-referring asymptomatic women with negative mammography and subgroups by age, previous cancer, breast density. Invasive assessment and surgical biopsy rate were evaluated.ResultsThe overall US detection was 1.85 per thousand (41/22,131). In the subgroups it was: 1.95 per thousand (22/11,274) in women <50 years vs 1.75 per thousand (19/10,857) in women ≥50 years (p = 0.42), 5.49 per thousand (12/2183) in women with previous cancer vs 1.45 per thousand (29/19,948) in women without cancer history (p = 0.0004), 2.21 per thousand (22/9960) in dense breasts (p = 0.17) vs 1.56 per thousand (19/12,171) in fatty breasts. The US generated invasive assessment was 1.9% (422/22,131). The benign to malignant open surgical biopsy ratio was 0.17 (7/41).ConclusionAdding US to negative mammography allowed for substantial incremental cancer detection rate (1.85 per thousand), particularly at age <50years, in women with previous breast cancer and in dense breasts.     

Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program

Background

To investigate perceived barriers to mammography among underserved women, we asked participants in the Siteman Cancer Center Mammography Outreach Registry–developed in 2006 to evaluate mobile mammography's effectiveness among the underserved–why they believed women did not get mammograms.

Methods

The responses of approximately 9,000 registrants were analyzed using multivariable logistic regression. We report adjusted odds ratios (OR) and 95% confidence intervals (CI) significant at 2-tailed P values less than .05.

Results

Fears of cost (40%), mammogram-related pain (13%), and bad news (13%) were the most commonly reported barriers. Having insurance was associated with not perceiving cost as a barrier (OR .44, 95% CI .40 to .49), but with perceiving fear of both mammogram-related pain (OR 1.39, 95% CI 1.21 to 1.60) and receiving bad news (OR 1.38, 95% CI 1.19 to 1.60) as barriers.

Conclusion

Despite free services, underserved women continue to report experiential and psychological obstacles to mammography, suggesting the need for more targeted education and outreach in this population.     

基层医院乳腺癌筛查模式的研究

目的探讨基层医院乳腺癌筛查的优化模式。方法对1998年1月至2006年12月新会地区的47976名妇女进行乳腺保健教育实施的乳腺临床检查加乳腺B超检查的乳腺癌筛查模式进行分析和总结。结果47976名妇女中筛查出乳腺异常情况者12694人,其中1126人接受手术活检或空心针穿刺活检,确诊为乳腺良性病变1069例,占94.1%,确诊为乳腺癌57例,占5.1%,其中非浸润性癌7例（均为T0期）,包括有小叶原位癌3例,导管内癌4例;浸润性癌50例,其中T1期是16例。本组乳腺癌筛查的乳腺癌检出率为0.12%。结论临床乳腺检查加乳腺B超检查的乳腺癌筛查模式能提高基层医院的乳腺癌早期诊断水平,有一定的临床推广价值。     

Breast cancer and bone mass in older women: is bone density prescreening for mammography useful?

Introduction The utility of screening mammography for older women with low bone mineral density (BMD) is controversial. This case-control study compares BMD at multiple sites in women with and without breast cancer to determine if BMD prescreening is useful in selecting women for continued screening mammograms.Methods Women diagnosed with breast cancer in the preceding 4 months and age-matched controls (±2 years) with a normal mammogram, all aged 65 years and older, were recruited on a 1:2 basis; 237 women participated: 79 women (cases) with breast cancer and 158 controls. BMD at the lumbar spine, hip, radius, and whole body was measured with dual x-ray absorptiometry (DXA).Results Among women with breast cancer, 17.1% had stage 0, 41.5% stage I, 40.0% stage II, and 1.4% stage III. Women with breast cancer had larger waist circumferences (p=0.002) and waist-hip ratios (p=0.01), and they exercised less (p=0.002) than women of the control group. However, there were no differences between the cases and controls for age, obesity, and reproductive and menopausal history variables, or other covariates (p>0.10). There were no differences in lumbar spine, total hip, femoral neck, midshaft radius, or total body BMD (p>0.10), although the cases had higher BMD at the ultradistal radius than the controls (means: 0.527 vs. 0.516, respectively; p=0.014). There were no differences in breast cancer risk by tertile of BMD or osteoporosis status at the hip or spine.Conclusion There is little difference in BMD between women with and without breast cancer. BMD is not useful as a prescreening predicator of mammography in older women and using it as such would result in cases of breast cancer being missed.