マンモグラフィのスクリーニングにおける年齢範囲の拡大:放射線保護の観点からの利益リスク評価
Theresa Hunger1, Elke Anna Nekolla1, Eva Wanka-Pail1
1Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany.
まとめ
マンモグラフィースクリーニングプログラム (MSP) を 45歳から75歳の女性にも適用することは有益で,乳がんによる死亡率を下げます. 高齢の女性は過剰診断され 若い女性は放射線のリスクが高くなりますが 全体の利益はこれらの懸念を上回ります
科学分野:
- 放射線医学と放射線腫瘍学
- 公衆衛生と疫学
- 腫瘍学
背景:
- マンモグラフィースクリーニングプログラム (MSP) は,ドイツとヨーロッパで50歳から69歳の女性向けに確立されています.
- 証拠は,この年齢圏外の女性にとって潜在的な利益と害を示唆しています.
研究 の 目的:
- 50歳未満と70歳以上の女性のマンモグラフィスクリーニングの利益リスクのバランスを評価する.
- 放射線保護の観点から,MSPの年齢制限の延長の影響を評価する.
主な方法:
- ランダム化制御試験 (RCT) の体系的レビューとメタ解析.
- 改変されたBEIR委員会モデルを用いた放射線関連終身リスク (LAR) の推定
- 乳がんの死亡率と過剰診断率の分析
主要な成果:
- 検診により乳がんの死亡率は70歳以上の女性では28%,39歳から49歳の女性では18%減少しました.
- 過剰診断の割合は年配の女性では19%と推定され,若い女性よりも高い.
- 75歳までスクリーニングを延長することは,利益とリスクの比率に最小の影響を及ぼしました.
結論:
- MSPの年齢制限を45歳から75歳まで延長することは,利益が放射能のリスクよりもはるかに大きいため,正当化されています.
- マンモグラフィーのスクリーニングは45~49歳と70~75歳の女性の乳がん死亡率を減らすことができます.
- ドイツは2024年2月にMSPを70~75歳の女性にも適用することを承認した.
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