美国预防服务工作组查指南和乳腺癌发病率的变化
Carina Zhang-Petersen1, Michelle Sowden1,2, Jennifer Chen3
1Department of Surgery, University of Vermont, Burlington.
JAMA network open
|December 27, 2024
概括
2009年美国预防服务特别工作组的指导方针变化减少了乳房扫描查,但没有导致更先进的乳腺癌诊断或更少的部分乳房切除术使用频率. 需要进一步的研究来理解这些趋势.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- 2009年,美国预防服务工作组 (USPSTF) 的指导方针变化建议不经常对乳腺癌进行乳房扫描查.
- 这些变化引发了人们对晚期乳腺癌诊断和更具侵略性的手术干预的潜在增加的担忧.
研究的目的:
- 评估2009年USPSTF指南变化对乳腺癌发病率的影响,按诊断时的阶段分别进行.
- 根据2009年指南修订,评估乳腺癌手术治疗比例的变化.
主要方法:
- 一项基于人口的流行病学队列研究,利用了国家癌症研究所的监测,流行病学和最终结果 (SEER) 计划 (2004-2019) 的数据.
- 分析包括超过200万名40岁或以上的女性,计算年龄和阶段特定的乳腺癌发病率和部分乳腺切除,全乳腺切除和全乳腺切除与重建的比例.
- 分析了2023年8月至2024年2月的数据,计算了年度百分比变化 (APC).
主要成果:
- 在现场乳腺癌的发病率在2009年后下降 (APC -0.69在50-74岁的女性中).
- 从2004年到2019年,局部乳腺癌发病率在40-74岁的女性中稳步增加 (50-74岁的女性APC为1.18),趋势没有改变.
- 在40-74岁的女性中,远距离乳腺癌的发病率从2012年起保持稳定,但在75岁以上的女性中增加 (APC 1.40).
- 从2004年到2012年,部分乳腺切除的比例下降,而整体乳腺切除与重建的比例显著增加 (APC 20.17). 从2012年到2019年,整体乳腺切除术减少,部分乳腺切除术增加.
结论:
- 2009年后乳房扫描查减少并没有导致诊断时晚期乳腺癌的比例更高.
- 观察到的 in situ 乳腺癌的减少与查减少一致,但并没有转化为更少的部分乳房切除术使用频率.
- 进一步的研究是有必要的,以了解在减少查的背景下,局部侵入性乳腺癌的持续增加和区域侵入性乳腺癌的减少.
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