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-2023-077039

摘要内容如下：

客观

探讨在英国13年筛查周期中，筛查发现异型性后乳腺癌的数量和类型与预期的每1000名筛查妇女中发现的11.3种癌症相比如何。

设计

英国斯隆异型性前瞻性队列的观察分析。

设置

通过英国国民健康保险制度（NHS）乳腺筛查计划向斯隆队列研究报告的异型性诊断。该队列与英国癌症登记处（English Cancer Registry）和死亡率与出生信息系统（Mortality and Birth Information System）相关联，以获取有关后续乳腺癌和死亡率的信息。

参与者

在2003年4月1日至2018年6月30日期间，有3238名妇女被诊断患有上皮异型性。

主要结果指标

根据异型性类型、年龄和诊断年份，在异型性诊断后1年、3年和6年检测到的浸润性乳腺癌的数量和类型。

结果

在2010年（n=119）和2015年（n=502）之间，在引入数字乳房X光检查后，异型性的检测增加了四倍。在异型性诊断后的19088人年的随访期间（截至2018年12月），141名妇女患上了乳腺癌。在异型性诊断后1年、3年和6年，每1000名异型性妇女的癌症累积发病率分别为0.95（95%置信区间0.28至2.69）、14.2（10.3至19.1）和45.0（36.3至55.1）。最近检测到异型性的妇女在三年内检测到后续癌症的比率较低（2013-18年为每1000名妇女6.0例侵袭性癌症（95%置信区间3.1至10.9），2003-07年为24.3例（13.7至40.1），2008-12年为24.6例（14.9至38.3））。随后的浸润性癌症的分级、大小和淋巴结转移与普通筛查人群中检测到的癌症相似，同侧和对侧癌症的数量相同。

结论

许多异型性可能代表风险因素，而不是短期内需要手术的侵袭性癌症的前兆。最近检测到异型性的女性，其后续癌症检出率较低，这可能与乳房X光检查和活检技术的变化有关，这些技术识别的异型性形式更有可能代表过度诊断。在异型性诊断后的短期内，每年一次的乳房X光检查可能不是有益的。需要更多关于长期风险的证据。

英文原文如下：

Abstracts

OBJECTIVE  To explore how the number and type of breast cancers developed after screen detected atypia compare with the anticipated 11.3 cancers detected per 1000 women screened within one three year screening round in the United Kingdom.

DESIGN  Observational analysis of the Sloane atypia prospective cohort in England.

SETTING  Atypia diagnoses through the English NHS breast screening programme reported to the Sloane cohort study. This cohort is linked to the English Cancer Registry and the Mortality and Birth Information System for information on subsequent breast cancer and mortality.

PARTICIPANTS  3238 women diagnosed as having epithelial atypia between 1 April 2003 and 30 June 2018.

MAIN OUTCOME MEASURES  Number and type of invasive breast cancers detected at one, three, and six years after atypia diagnosis by atypia type, age, and year of diagnosis.

RESULTS  There was a fourfold increase in detection of atypia after the introduction of digital mammography between 2010 (n=119) and 2015 (n=502). During 19 088 person years of follow-up after atypia diagnosis (until December 2018), 141 women developed breast cancer. Cumulative incidence of cancer per 1000 women with atypia was 0.95 (95% confidence interval 0.28 to 2.69), 14.2 (10.3 to 19.1), and 45.0 (36.3 to 55.1) at one, three, and six years after atypia diagnosis, respectively. Women with atypia detected more recently have lower rates of subsequent cancers detected within three years (6.0 invasive cancers per 1000 women (95% confidence interval 3.1 to 10.9) in 2013-18 v 24.3 (13.7 to 40.1) in 2003-07, and 24.6 (14.9 to 38.3) in 2008-12). Grade, size, and nodal involvement of subsequent invasive cancers were similar to those of cancers detected in the general screening population, with equal numbers of ipsilateral and contralateral cancers.

CONCLUSIONS  Many atypia could represent risk factors rather than precursors of invasive cancer requiring surgery in the short term. Women with atypia detected more recently have lower rates of subsequent cancers detected, which might be associated with changes to mammography and biopsy techniques identifying forms of atypia that are more likely to represent overdiagnosis. Annual mammography in the short term after atypia diagnosis might not be beneficial. More evidence is needed about longer term risks.

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