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确诊导管原位癌的女性发生浸润性乳腺癌和乳腺癌死亡的长期风险较高
作者:小柯机器人 发布时间:2020/5/28 17:40:55

英国牛津大学Gurdeep S Mannu团队探讨了1998-2014年英国筛查确诊导管原位癌后发生浸润性乳腺癌和因乳腺癌死亡的风险。2020年5月27日,《英国医学杂志》发表了这一成果。

为了评估乳腺筛查确诊导管原位癌(DCIS)后浸润性乳腺癌和因乳腺癌死亡的长期风险,研究组进行了一项基于人群的观察性队列研究。使用NHS乳房筛查项目和美国国家癌症登记和分析服务的数据,1988年至2014年3月,共有35024名英国女性被诊断患有DCIS。主要结局指标为突发性浸润性乳腺癌和因乳腺癌导致的死亡。

截至2014年12月,研究组对13606名女性进行了长达5年的随访,对10998名女性进行了5-9年的随访,对6861名进行了10-14年的随访,对2620名进行了15-19年的随访,对939名进行了至少20年的随访。这些女性中有2076名患上浸润性乳腺癌,发生率为每年每千名女性8.82例,是全国癌症发生率的两倍以上。患病率在确诊为DCIS后的第二年开始增加,且一直持续到随访结束。

在同一组女性中,有310名死于乳腺癌,相当于每年每千名女性死亡1.26例,比全国乳腺癌死亡率的预期值高70%。在确诊DCIS后的前五年中,乳腺癌死亡率与全国预期死亡率中很接近,预期比率为0.87;但随后增加,在DCIS确诊后的5-9年比率为1.98,10-14年为2.99,15年以上为2.77。在29044名接受单侧DCIS手术的女性中,那些接受更深度治疗(乳房切除术、保乳手术+放疗、雌激素受体阳性疾病的内分泌治疗)的女性和最终手术余地较大的女性浸润性乳腺癌发生率较低。

总之,在确诊后至少二十年内,通过筛查发现的DCIS女性平均而言比普通人群具有更高的浸润性乳腺癌和因乳腺癌死亡的长期风险。更深入的治疗和更大的最终手术余地可显著降低浸润性乳腺癌的风险。

附:英文原文

Title: Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study

Author: Gurdeep S Mannu, Zhe Wang, John Broggio, Jackie Charman, Shan Cheung, Olive Kearins, David Dodwell, Sarah C Darby

Issue&Volume: 2020/05/27

Abstract: Objective To evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening.

Design Population based observational cohort study.

Setting Data from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service.

Participants All 35024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014.

Main outcome measures Incident invasive breast cancer and death from breast cancer.

Results By December 2014, 13606 women had been followed for up to five years, 10998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer.

Conclusions To date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.

DOI: 10.1136/bmj.m1570

Source: https://www.bmj.com/content/369/bmj.m1570

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj