3740例社区女性乳腺癌筛查结果分析

目的了解社区健康女性乳房钼靶筛查效果及乳腺癌危险因素。方法 2008年6月—2009年6月在上海市闵行区七宝社区居委、村委开展35～74岁女性危险因素问卷调查、乳房临床触诊及钼靶筛查。结果筛查3740例,检出乳腺癌16例,检出率427.81/10万,早期13例,其中原位癌3例,早期率81.25%;钼靶筛查原位癌比例高于非筛查人群;左右乳分别有1.15%及1.52%人群不宜参加钼靶筛查,集中于40～59岁人群,左右乳完全正常的占63.17%,62.42%,35.68%及36.06%的左右乳分别存在良恶性病变,可能良性疾病左右乳均集中于50～59岁;钼靶筛查灵敏度为0.93,特异度为0.98,约登指数0.92,阳性似然比53.47,阴性似然比0.07,一致率0.98,阳性预测值0.18,阴性预测值0.99。临床触诊灵敏度为0.75,特异度为0.42,约登指数0.17,阳性似然比1.30,阴性似然比0.59,一致率0.43,阳性预测值0.01,阴性预测值0.99;35～74岁钼靶普及率为15.24%;哺乳时间超过6个月是乳腺癌发病的保护因素(OR=0.30,95%CI:0.10～0.89),而一侧乳房癌史导致对侧乳房癌发病相对危险度为9.21(95%CI:1.05～81.07)。结论 35～74岁健康女性适宜开展钼靶筛查,临床触诊筛查具有一定效果。应加强健康教育,推广钼靶筛查,提倡哺乳。

The Breast Cancer Screening Results of 3 740 Female Residents in a Community of Minhang District of Shanghai

Objective To understand the effects of mammography screening for female breast cancer and risk factors for breast cancer. Methods From June 2008 to June 2009, 3740 females aged 35-74 yrs old from Qibao community of Minhang district of Shanghai were investigated with questionnaire, and taken clinical and mammography breast examination. Results Total 16 cases with breast cancer were screened out and the rate was 427.81/100 000, of which 13 cases were in early phase and 3 cases were carcinoma in situ. The early cancer rate was 81.25%. The case proportion of carcinoma in situ by mammography screening was significantly higher in the screening population than in the non-screening population.1.15% right and 1.52% left breasts focusing on 40-59 yrs were not suitable for mammography screening. The case proportion of completely normal left and right breast was 63.17% and 62.42%. The proportions of benign and malignant lesions were 35.68% in the left breasts and 36.06% in the right ones. The sensitivity and specificity of mammography screening was 0.93 and 0.98, Youden＇s index was 0.92, positive likelihood ratio 53.47, negative likelihood ratio 0.07, consistent rate 0.98, positive predictive value 0.18, negative predictive value 0.99. But the sensitivity and specificity of clinical breast examination was 0.75 and 0.42, Youden＇s index 0.17, positive likelihood ratio 1.30, negative likelihood ratio 0.59, consistent rate 0.43, positive predictive value 0.01, negative predictive value 0.99. The rate of mammography examination popularization was 15.24. Breast-feeding longer than six months was a protective factor for breast cancer （OR=0.30, 95%CI： 0.10-0.89）. The relative risk of breast cancer incidence was 9.21 by the history of breast cancer. Conclusion 35-74 year-old women should take the mammography screening plan. Education should be added to promote mammography screening and breast feeding for infants.