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.2023.24766

摘要内容如下：

重要性

乳腺癌发病率的变化以及筛查和治疗的进展对不同筛查策略结果的影响还不是很清楚。

目的

评估各种乳腺摄影筛查策略的结果。

设计、设置和填充

使用6个癌症干预和监测模型网络（CISNet）模型和国家数据比较以前没有癌症诊断的美国妇女的乳腺癌发病率、乳房X光检查性能、治疗效果和其他原因死亡率的结果。

曝光

36种筛查策略，开始年龄（40、45、50岁）和停止年龄（74、79岁）各不相同，每年、每两年或间隔组合进行数字乳房X光检查或数字乳房断层合成（DBT）。对所有女性和黑人女性的策略进行了评估，假设100%的筛查依从性和“真实世界”的治疗。

主要成果和措施

估计的终生受益（避免乳腺癌死亡、乳腺癌死亡率降低百分比、生命年数增加）、危害（假阳性召回、良性活检、过度诊断）和每1000名妇女的乳房X光检查次数。

结果

从40岁、45岁或50岁开始，每两年进行一次DBT筛查，直到74岁，与不进行筛查相比，每1000名接受筛查的妇女中，分别避免了8.2、7.5或6.7例乳腺癌死亡。在40至74岁时每两年进行一次DBT筛查（与无筛查相比），乳腺癌死亡率降低30.0%，每1000名接受筛查的妇女中有1376例假阳性病例和14例过度诊断病例。数字乳腺摄影筛查的益处与DBT相似，但有更多的假阳性回忆。每年筛查增加了益处，但导致更多的假阳性召回和过度诊断病例。持续筛查至79岁的获益-害比与74岁停止筛查的获益-害比相似或更优。在所有策略中，乳腺癌风险高于平均水平、乳腺密度较高且合并症水平较低的妇女比其他组的筛查获益更大。对40至49岁的黑人妇女每年进行一次筛查，此后每两年进行一次筛查，降低了乳腺癌死亡率差异，同时保持了与所有妇女类似的利弊权衡。

结论

该模型分析表明，从40岁开始每两年进行一次乳房X光筛查可降低乳腺癌死亡率，并增加每次乳房X光检查获得的生命年数。对乳腺癌诊断或死亡风险较高的妇女进行更密集的筛查，可以保持类似的利弊权衡，并减少死亡率差异。

英文原文如下：

Abstracts

Importance  The effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known.

Objective  To estimate outcomes of various mammography screening strategies.

Design, Setting, and Population  Comparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses.

Exposures  Thirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and "real-world" treatment.

Main Outcomes and Measures  Estimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women.

Results  Biennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women.

Conclusions  This modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities.

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