2014—2019年北京城市癌症早诊早治项目女性乳腺癌筛查结果分析

Breast cancer screening in urban Beijing,2014-2019

目的分析2014—2019年北京城市癌症早诊早治项目女性乳腺癌筛查结果。方法基于国家城市癌症早诊早治项目,采用整群抽样的方法,以北京市东城、西城、朝阳、海淀、丰台和石景山区的80个筛查项目实施街道为研究现场,将街道/居委会所辖的40~69岁北京市户籍常住女性居民纳入研究。采用问卷调查、风险评估、临床筛查(单纯乳腺B超、乳腺B超和乳腺X线摄影并联筛查)以及随访的方式收集研究对象的相关危险因素、临床筛查结果以及健康结局(乳腺癌),计算乳腺癌初筛阳性率、临床筛查参与率、临床筛查可疑阳性率、阳性率、早诊率、发病密度、累积发病率,并采用Cox比例风险回归模型分析不同筛查方式与乳腺癌发病风险的关联。结果53916名研究对象年龄为(57.2±7.3)岁;超重、肥胖者分别占40.90%(22053)和15.34%(8270);17535例(32.52%)被评估为初筛阳性。初筛阳性人群中接受临床筛查的参与率为47.64%(8353名),其中单纯经B超或乳腺X线摄影筛查得到的阳性检出率分别为1.84%和4.00%,可疑阳性检出率分别为14.50%和17.83%;B超和乳腺X线摄影并联筛查得到的阳性率和可疑阳性率分别为5.44%和27.74%;平均随访观察2.68人年后,确诊乳腺癌252例,累积发病率和发病密度分别为467.39/10万、174.34/10万人年。接受临床筛查者确诊乳腺癌的早诊率为68.6%。Cox比例风险回归模型分析结果显示,与问卷初筛阴性者相比,问卷阳性者发生乳腺癌的风险HR(95%CI)值为1.55(1.20~2.00);与并联筛查阴性者相比,并联筛查阳性者和可疑阳性者乳腺癌发生风险HR(95%CI)值分别为12.60(6.49~24.47)、1.89(0.93~3.83)。结论北京城市癌症早诊早治项目女性乳腺癌临床筛查依从性较好;乳腺B超与乳腺X线摄影并联筛查可能提高乳腺癌的阳性检出率。

Objective To analyze the current status of breast cancer screening among females in Urban Beijing Cancer Screening Program,2014-2019.Methods Based on an on‑going cancer screening program launched by the National Urban Cancer Screening Program,women residences aged 40 to 69 were recruited from 80 streets in six districts of Beijing(Dongcheng,Xicheng,Chaoyang,Haidian,Fengtai and Shijingshan District)using cluster sampling method.General demographic information and potential risk factors,results of clinical examination and follow‑up outcomes of the target population(diagnosed breast cancer or not)were collected using epidemiological questionnaire,risk evaluation,clinical examination using ultrasound and(or)joint screening with mammography and follow‑up,respectively.Proportion of high‑risk cases evaluated by the questionnaire,recall rate,proportion of cases with BI‑RADS grade 3 and BI‑RADS grade 4/5,proportion of the cases with stage 0 or I,incidence rate and cumulative incidence rate were calculated.Cox proportional hazard regression model was used to estimate the hazard ratio(HR)and 95%confidence interval(95%CI)among females who experienced different screening scenario.Results A total of 53916 women with the age of(57.2±7.3)completed high‑risk assessment were included into analysis.The proportion of overweigh and obesity were 40.90%(22053 cases)and 15.34%(8270 cases),respectively.A total of 17535 cases(32.52%)were evaluated as positive case detected by the questionnaire.The clinical recall rate was 47.64%(8353 cases)among the high‑risk females.The positive rate detected by ultrasound or mammography alone was 1.84%and 4.00%,while the suspicious positive detection rates were 14.50%and 17.83%,respectively.The positive rate and suspicious positive rate detected by joint screening using ultrasound and mammography were 5.44%and 27.74%respectively.In total,252 cases were diagnosed with breast cancer after an average of 2.68 years follow‑up.The incidence rate and cumulative incidence rate of breast cancer were 174.34/100000 person years and 470/100000,respectively.The early detection rate was 68.6%among the residences who received clinical examination.Compared with the negative residence evaluated by the questionnaire,the positive cases has a 55%higher risk of diagnosed with breast cancer(HR=1.55,95%CI:1.20-2.00);Cases that recognized by baseline ultrasound and mammography joint screening as BI‑RADS 4/5 and BI‑RADS 3 have higher risk of diagnosed with breast cancer than that of with the results of BI‑RADS 1-2,with the HR of 12.60(95%CI:6.49-24.47)and 1.89(0.93-3.83),respectively.Conclusion Females with high risk of breast cancer in Beijing have a better recall rate of receiving the clinical screening examination.Joint using ultrasonography and mammography in breast cancer screening can improve the positive detection rate among high risk females.