山东省肥城市2008-2011年乳腺癌筛查结果分析

Screening for breast cancer in Feicheng,Shandong Province,2008-2011

目的:分析2008-2011年肥城市乳腺癌筛查项目结果,了解肥城市乳腺癌发病情况,探讨理想的乳腺癌筛查模式。方法:方案1对全部筛查对象进行临床乳腺检查和超声检查,阳性和可疑者进一步行钼靶X射线检查;方案2对3 000名45～64岁城市受检者采用临床、超声和钼靶X射线检查(MAM)联合筛查;所有乳腺癌病例最终经病理确诊。采用单因素χ2检验和筛检试验进行资料分析。结果:肥城市近4年初筛人群乳腺癌总体检出率为122.3/10万(26/21 256),复查人群检出率为66.8/10万(3/4 493)。标化后城市妇女各年龄段乳腺癌检出率均远高于农村妇女,城市妇女总的标化检出率为168.6/10万,农村妇女总的标化检出率为3.4/10万。农村妇女对项目的参与度较低,且早期癌发现率较低。方案1与方案2对乳腺癌的检出率差异无统计学意义,但前者相对后者更加经济有效。结论:肥城市乳腺癌检出率相对较高,应加强和规范农村妇女乳腺疾病的普查和诊治工作,临床检查、B超筛检高危人群进行钼靶X射线检查的模式具有经济、早期癌检出率高的特点,适合在基层或社区推广应用。

OBJECTIVE: To analyze the results of breast cancer screening program in Feicheng,2008-2011,find out the incidence of breast cancer,and explore the ideal early detection mode of screening for breast cancer.METHODS: Two schemes were used in the programme.The first one was that all subjects received clinical breast examination(CBE) and ultrasonography(US),and suspicious cases received mammography(MAM).Totally 3000 citizen women aged 45-64 underwent the second screening sessions(CBE,MAM,US used in combination).All cases will ultimately be diagnosed by pathology.χ2 test and screening test were used to analyze the results of the programme.RESULTS: From 2008 to 2011,the average detection rate of breast cancer in the first screening populations was 122.3/100 000(26/21 256),and the rate of the reviewing population was 66.8/100 000(3/4 493).There were statistical differences among the detection rates of different age groups between the citizen and rural women after standardization.The total standardized rate of the citizen women was 168.6/100 000 while the rate in rural areas was 3.4/100 000.Some rural women were reluctant to participate in breast cancer screening,and the early cancer detection rate was lower.The accuracy of clinical examination,ultrasonography and mammography used together was relatively higher than other ways.The first scheme was more economic and effective than the second one though there were no statistical differences between them.CONCLUSIONS: The screening suggests a higher detection rate of breast cancer in women in Feicheng.Screening and diagnosis for breast cancer should be strengthened and standardized in rural areas.The scheme that MAM was used in high-risk groups who were determined by CBE and US was effective and suitable for promotion in community application.