本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-075498

摘要内容如下：

目标

评估非筛查检测导管原位癌后，浸润性乳腺癌和乳腺癌相关死亡的长期风险。比较了普通人群中的女性和通过筛查程序诊断为导管原位癌的女性的风险。

设计

基于人群的队列研究。

设置

来自国家疾病登记服务的数据。

参与者

在1990年至2018年期间，英国所有27543名女性在英国国民健康保险制度（NHS）乳腺筛查计划之外被诊断为导管原位癌。

主要结果指标

侵袭性乳腺癌事件和乳腺癌导致的死亡。

结果

截至2018年12月31日，3651名未筛查出导管原位癌的女性发展为浸润性乳腺癌，比全国癌症发病率的预期值高出四倍多（观察值与预期值之比为4.21（95%会议间隔4.07至4.35））。在随访期间，年龄<45-70岁的女性发生浸润性乳腺癌的观察率与预期率之比持续增加。根据诊断为导管原位癌时的年龄，浸润性乳腺癌的25年累积风险为：<45岁为27.3%，45-49岁为25.2%，50-59岁为21.7%，60-70岁为20.8%。908名妇女死于乳腺癌，几乎是一般人口中乳腺癌死亡率预期值的四倍（观察值与预期值之比为3.83（3.59比4.09））。在整个随访过程中，观察到的乳腺癌死亡率与预期死亡率的比率一直在增加。导管原位癌诊断时按年龄划分的乳腺癌死亡的25年累积风险为：<45岁为7.6%，45-49岁为5.8%，50-59岁为5.9%，60-70岁为6.2%。在50-64岁的妇女中，因此有资格接受英国国民健康保险制度（NHS）的乳腺筛查，与筛查发现的导管原位癌相比，未筛查发现的浸润性乳腺癌的观察率与预期率之比为1.26（95%会议间隔1.17至1.35），而乳腺癌的死亡率之比为1.37（1.17至1.60）。在22753例接受手术的单侧导管原位癌患者中，接受乳房切除术而非保乳手术的患者同侧浸润性乳腺癌的25年累积发生率较低（乳房切除术8.2%（95%会议间隔7.0%至9.4%），保乳手术加放疗19.8%（16.2%至23.4%），保乳手术不加放疗20.6%（18.7%至22.4%））。然而，死亡率的降低并没有转化为乳腺癌25年累积死亡率的降低（乳房切除术6.5%（4.9%至10.9%），保乳手术加放疗8.6%（5.9%至15.5%），保乳手术不加放疗7.8%（6.3%至11.5%））。

结论

在确诊后至少25年内，未筛查出导管原位癌的女性患浸润性乳腺癌和乳腺癌死亡的长期风险高于普通人群中的女性。此外，她们的长期风险高于筛查发现导管原位癌的女性。与保乳手术相比，乳房切除术与较低的浸润性乳腺癌风险相关，即使伴有放疗。然而，乳腺癌死亡风险在乳房切除术、放疗保乳手术和无放疗记录的保乳手术中表现相似。

英文原文如下：

Abstracts

OBJECTIVES  To evaluate the long term risks of invasive breast cancer and death related to breast cancer after non-screen detected ductal carcinoma in situ. Risks for women in the general population and for women diagnosed with ductal carcinoma in situ via the screening programme were compared.

DESIGN  Population based cohort study.

SETTING  Data from the National Disease Registration Service.

PARTICIPANTS  All 27 543 women in England who were diagnosed with ductal carcinoma in situ, outside the NHS breast screening programme, during 1990 to 2018.

MAIN OUTCOME MEASURES  Incident invasive breast cancer and death caused by breast cancer.

RESULTS  By 31 December 2018, 3651 women with non-screen detected ductal carcinoma in situ had developed invasive breast cancer, more than four times higher than expected from national cancer incidence rates (ratio of observed to expected rate was 4.21 (95% conference interval 4.07 to 4.35)). The ratio of observed to expected rate of developing invasive breast cancer remained increased throughout follow-up among women aged <45-70 years. The 25 year cumulative risks of invasive breast cancer by age at diagnosis of ductal carcinoma in situ were 27.3% for <45 years, 25.2% for 45-49 years, 21.7% for 50-59 years, and 20.8% for 60-70 years. 908 women died of breast cancer, almost four times higher than that expected from breast cancer death rates in the general population (ratio of observed to expected rate 3.83 (3.59 to 4.09)). The ratio of observed to expected rate of mortality attributed to breast cancer remained increased throughout follow-up. The 25 year cumulative risks of breast cancer death by age at ductal carcinoma in situ diagnosis were 7.6% for <45 years, 5.8% for 45-49 years, 5.9% for 50-59 years, and 6.2% for 60-70 years. Among women aged 50-64 years, and therefore eligible for breast screening by the NHS, the ratio of observed to expected rate of invasive breast cancer in women with non-screen detected compared with screen detected ductal carcinoma in situ was 1.26 (95% conference interval 1.17 to 1.35), while the ratio for mortality from breast cancer was 1.37 (1.17 to 1.60). Among 22 753 women with unilateral ductal carcinoma in situ undergoing surgery, those who had mastectomy rather than breast conserving surgery had a lower 25 year cumulative rate of ipsilateral invasive breast cancer (mastectomy 8.2% (95% conference interval 7.0% to 9.4%), breast conserving surgery with radiotherapy 19.8% (16.2% to 23.4%), and breast conserving surgery with no radiotherapy recorded 20.6% (18.7% to 22.4%)). However, reductions did not translate into a lower 25 year cumulative rate of deaths attributable to breast cancer (mastectomy 6.5% (4.9% to 10.9%), breast conserving surgery with radiotherapy 8.6% (5.9% to 15.5%), breast conserving surgery with no radiotherapy recorded 7.8% (6.3% to 11.5%)).

CONCLUSIONS  For at least 25 years after their diagnosis, women with non-screen detected ductal carcinoma in situ had higher long term risks of invasive breast cancer and breast cancer death than women in the general population. Additionally, they had higher long term risks than women with screen detected ductal carcinoma in situ. Mastectomy was associated with lower risks of invasive breast cancer than breast conserving surgery, even when accompanied by radiotherapy. However, risks of breast cancer death appeared similar for mastectomy, breast conserving surgery with radiotherapy, and breast conserving surgery with no radiotherapy recorded.

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