云南省广南县乳腺疾病筛查结果分析

Mass screening results of breast diseases in Guangnan County of Yunnan Province

目的调查云南省广南县妇女乳腺疾病患病情况,并探索适合偏远地区的乳腺疾病筛查模式。方法以随机抽查方式收集2016年3月25日至2016年4月3日广南县7个镇共7 793名妇女的基本信息,采用体检+超声为主,辅以乳腺X线检查及活组织检查的方式进行乳腺疾病筛查,并用χ^2检验分析不同民族、不同年龄组间乳腺异常检出率的差异,以及BI-RADS 4~ 5级病例在不同年龄组中分布的情况。结果本次抽查人群中有2 376名妇女为乳腺异常病例(即超声提示BI-RADS 0级或2~5级病例),检出率为30.5%(2 376/7 793)。不同民族乳腺异常检出率如下:汉族为29.9%(1 286/4 302),壮族为33.6%(873/2 595),彝族为23.5%(130/553),苗族为25.6%(30/117),白族为45.8%(22/48),瑶族为18.6%(8/43),回族为11.4%(4/35),蒙古族为23.3%(7/30),傣族为0(0/22),哈尼族为54.5%(12/22),土家族为4/13,侗族为0(0/9),布依族为0(0/4)。各民族间乳腺异常检出率差异有统计学意义(χ^2=63.187, P <0.001),其中,壮族与汉族比较,乳腺异常检出率差异有统计学意义(χ^2=10.577, P <0.002)。不同年龄组患者乳腺异常检出率如下:18~25岁者为11.9%(119/998),26~35岁者为26.0%(901/3 460),36~45岁者为39.2%(896/2 283),46~55岁者为46.9%(446/951),56~73岁者为13.9%(14/101)。各年龄组间乳腺异常检出率差异有统计学意义(χ^2=411.231, P <0.001),其中,46~55岁者乳腺异常检出率最高。并且,不同年龄组中BI-RADS 4~ 5级病例检出率如下:18~25岁组为0.1%(1/998),26~35岁组为0.7%(24/3 460),36~45岁组为0.9%(20/2 283),46~55岁组为0.9%(9/951),56~73岁组为5.0%(5/101)。各年龄组间BI-RADS 4~ 5级病例检出率差异有统计学意义(χ^2=30.438, P <0.001),其中,56~73岁组妇女BI-RADS 4~ 5级病例检出率最高。结论云南省广南县壮族妇女乳腺异常检出率比汉族高,因此,应加强筛查,并进一步探索其病因;同时,应加强对 46~ 73岁年龄段妇女的乳腺疾病筛查,尤其是56~73岁年龄段的妇女,以便早期发现、早期治疗乳腺恶性肿瘤;体检+超声为主并辅以乳腺X线检查及活组织检查的方式,可能是适合于农村和基层医疗保健机构进行乳腺疾病筛查的模式。

Objective To investigate the prevalence of breast diseases in women in Guangnan County, Yunnan Province by a random sampling method and explore a mass screening mode for breast diseases in remote areas. Methods A total of 7 793 women from 7 towns in Guangnan County from March 25, 2016 to April 3, 2016 were enrolled by random sampling. They underwent physical examination and ultrasonography, supplemented by mammography and biopsy, in order to detect breast diseases.χ^2 test was used to compare the detection rate of breast abnormalities among different ethnic groups and age groups, and the distribution of BI-RADS 4-5 lesions among different age groups. Results There were 2 376 patients with breast abnormalities (US BI-RADS 0 or 2-5), accounting for 30.5%(2 376/7 793). The detection rate of breast abnormalities in different ethnic groups was as follow: 29.9%(1 286/4 302) in Han nationality, 33.6%(873/2 595) in Zhuang, 23.5%(130/553) in Yi, 25.6%(30/117) in Miao, 45.8%(22/48) in Bai, 18.6%(8/43) in Yao, 11.4%(4/35) in Hui, 23.3%(7/30) in Mongol, 0 (0/22) in Dai, 54.5%(12/22) in Hani, 4/13 in Tujia, 0 (0/9) in Dong and 0 (0/4) in Buyi. There was a significant difference in the detection rate among different ethnic groups (χ^2=63.187, P <0.001), between Zhuang and Han nationality (χ^2=10.577, P <0.002). The detection rate of breast abnormalities in different age groups was as follow: 11.9%(119/998) in the age group of 18-25 years, 26.0%(901/3 460) in 26-35 years, 39.2%(896/ 2 283 ) in 36-45 years, 46.9%(446/951) in 46- 55 years, and 13.9%(14/101) in 56-73 years. There was a significant difference in the detection rate among different age groups (χ^2=411.231, P <0.001). The patients at the age of 46-55 years had the highest detection rate of breast abnormalities. The detection rate of BI-RADS 4-5 lesions in different age groups was as follow: 0.1%(1/998) in the age group of 18-25 years, 0.7%(24/3 460) in 26- 35 years, 0.9%(20/2 283) in 36-45 years, 0.9%(9/951) in 46-55 years, and 5.0%(5/101) in 56-73 years. There was a significant difference in the detection rate of BI-RADS 4-5 lesions among different age groups (χ^2=30.438, P <0.001). The patients at the age of 56-73 years had the highest detection rate of BI-RADS 4-5 lesions. Conclusions The women of Zhuang ethnic group in Guangnan County, Yunnan Province have a higher detection rate of breast abnormalities compared with Han nationality, so further screening and research are needed. The screening for breast diseases in women at the age of 46- 73 years, especially 56- 73 years, should be strengthened for early detection and treatment of breast malignancies. The physical examination and ultrasonography supplemented by mammography and biopsy may be feasible for breast disease screening in rural area and primary health care institutions.