本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.25881

摘要内容如下：

重要性

1975年至2019年间，美国乳腺癌死亡率有所下降。转移性乳腺癌治疗的变化与乳腺癌死亡率改善之间的关系尚不清楚。

目的

模拟乳腺癌筛查、I期至III期乳腺癌的治疗和转移性乳腺癌的治疗与乳腺癌死亡率改善的相关性。

设计、设置和参与者

使用关于筛查和治疗的传播和效果的汇总观察和临床试验数据，4个癌症干预和监测模型网络（CISNet）模型模拟了美国乳腺癌死亡率。模拟了1975年至2019年美国30至79岁女性因乳腺癌死亡的总体情况以及雌激素受体和ErbB2（以前的HER2）状态。

曝光

乳房X光筛查、I期至III期乳腺癌的治疗以及转移性乳腺癌的治疗。

主要成果和措施

评估了与筛查、I至III期治疗和转移治疗相关的模型估计的年龄调整乳腺癌死亡率，以及模型估计的乳腺癌转移复发后的中位生存率。

结果

1975年，美国乳腺癌死亡率（年龄调整后）为48/10万，2019年为27/10万。2019年，筛查、I-III期治疗和转移治疗的组合与乳腺癌死亡率降低58%（模型范围，55%-61%）相关。其中，29%（模型范围，19%-33%）与转移性乳腺癌的治疗有关，47%（模型范围，35%-60%）与I期至III期乳腺癌的治疗有关，25%（模型范围，21%-33%）与乳房X光筛查有关。根据模拟，转移复发后生存期的最大变化发生在2000年至2019年之间，从1.9年（模型范围，1.0-2.7年）到3.2年（模型范围，2.0-4.9年）。雌激素受体（ER）阳性/erbB2阳性乳腺癌的中位生存期提高了2.5年（模型范围，2.0-3.4年），而ER-/erbB2-乳腺癌的中位生存期提高了0.5年（模型范围，0.3-0.8年）。

结论和相关性

根据4个模拟模型，与1975年的干预措施相比，2019年的乳腺癌筛查和治疗与美国乳腺癌死亡率降低58%相关。模拟表明，I至III期乳腺癌的治疗与死亡率降低约47%相关，而转移性乳腺癌的治疗与死亡率降低29%相关，筛查与死亡率降低25%相关。

英文原文如下：

Abstracts

Importance  Breast cancer mortality in the US declined between 1975 and 2019. The association of changes in metastatic breast cancer treatment with improved breast cancer mortality is unclear.

Objective  To simulate the relative associations of breast cancer screening, treatment of stage I to III breast cancer, and treatment of metastatic breast cancer with improved breast cancer mortality.

Design, Setting, and Participants  Using aggregated observational and clinical trial data on the dissemination and effects of screening and treatment, 4 Cancer Intervention and Surveillance Modeling Network (CISNET) models simulated US breast cancer mortality rates. Death due to breast cancer, overall and by estrogen receptor and ERBB2 (formerly HER2) status, among women aged 30 to 79 years in the US from 1975 to 2019 was simulated.

Exposures  Screening mammography, treatment of stage I to III breast cancer, and treatment of metastatic breast cancer.

Main Outcomes and Measures  Model-estimated age-adjusted breast cancer mortality rate associated with screening, stage I to III treatment, and metastatic treatment relative to the absence of these exposures was assessed, as was model-estimated median survival after breast cancer metastatic recurrence.

Results  The breast cancer mortality rate in the US (age adjusted) was 48/100 000 women in 1975 and 27/100 000 women in 2019. In 2019, the combination of screening, stage I to III treatment, and metastatic treatment was associated with a 58% reduction (model range, 55%-61%) in breast cancer mortality. Of this reduction, 29% (model range, 19%-33%) was associated with treatment of metastatic breast cancer, 47% (model range, 35%-60%) with treatment of stage I to III breast cancer, and 25% (model range, 21%-33%) with mammography screening. Based on simulations, the greatest change in survival after metastatic recurrence occurred between 2000 and 2019, from 1.9 years (model range, 1.0-2.7 years) to 3.2 years (model range, 2.0-4.9 years). Median survival for estrogen receptor (ER)-positive/ERBB2-positive breast cancer improved by 2.5 years (model range, 2.0-3.4 years), whereas median survival for ER-/ERBB2- breast cancer improved by 0.5 years (model range, 0.3-0.8 years).

Conclusions and Relevance  According to 4 simulation models, breast cancer screening and treatment in 2019 were associated with a 58% reduction in US breast cancer mortality compared with interventions in 1975. Simulations suggested that treatment for stage I to III breast cancer was associated with approximately 47% of the mortality reduction, whereas treatment for metastatic breast cancer was associated with 29% of the reduction and screening with 25% of the reduction.

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