中国南方女性乳腺癌筛查“逸仙模式”初步结果分析

Preliminary results of the SYSU strategy for screening breast cancerin southern Chinese women

乳房X线检查是目前唯一被证明可以降低乳腺癌死亡率的筛查方法.然而,乳房X线检查对年轻、乳房小而致密的女性的检测准确度下降,尤其在亚洲女性中较为常见.因此,本团队开展了中山大学孙逸仙纪念医院乳腺筛查模式(简称“逸仙模式”),通过联合运用乳腺超声和乳房X线,对具有高乳腺密度和较高乳腺癌发病率的中国南方地区女性进行乳腺癌筛查.本研究共纳入2013~2018年22~89岁参与南方职业女性乳腺癌筛查项目的女性28621例.运用逸仙乳腺癌筛查模式,即年龄≥40岁参检者接受乳腺超声联合乳房X线检查,年龄<40岁参检者仅接受乳腺超声检查,并均进行为期1年的随访.28621名妇女共检出乳腺癌39例(1.36/1000).其中,<40岁单一乳腺超声检查组有6例乳腺癌(0.48/1000),≥40岁乳腺超声联合乳腺X线检查组有33例(2.05/1000),两者间差异具有统计学意义(P<0.001).在联合筛查模式组中,仅有8例(24.2%)仅通过乳房X线检测到癌症,剩下22人(66.7%)既可以从超声检查中发现,也可以从乳腺X线检查中发现.大部分乳腺癌患者影像学表现仍是以肿块型为主,但肿块型乳腺癌和钙化型乳腺癌的比例在各个年龄段中无明显差异(P=0.632).且对于钙化型乳腺癌,目前仍是以乳腺X线发现为主.就临床分期而言,0期及Ⅰ期乳腺癌在单一乳腺超声组(66.7%,4/6)及联合筛查模式(66.7%,22/33)均超过半数,两组间比例差异无统计学意义(P=0.507).中山大学逸仙乳腺癌筛查模式是一种可适用于中国南方地区女性乳腺癌筛查的替代方法.

Mammography is the only screening method that has been found to reduce the mortality of breast cancer.However,it has been reported to be inaccurate in young women or women with small and dense breasts,a feature that is very common in Asian women.This study investigated a novel breast cancer screening strategy(SYSU strategy)based on ultrasonography and mammography for Southern Chinese women who have a high proportion of dense breasts and a high prevalence in young breast cancer.A total of 28,621 women aged 22–89 years were enrolled in this study between 2013–2018.They all attended the Southern Professional Women Breast Cancer Screening Project with an organized breast cancer screening.The SYSU breast cancer screening strategy involves participants who are older than 40 years being screened by ultrasound and mammography and those younger than 40 years screened by ultrasound alone at enrolment and 1-year follow-up.A total of 39 breast cancers were detected during the screening period(1.36/1000).Among the cancers detected,6 breast cancers(0.48/1000)were identified by ultrasound alone in women younger than 40 years,and 33 cancers(2.05/1000)were identified by the combination of ultrasound and mammography(P<0.001).However,in the combined group,only 8 cancers(24.2%)were detected by mammography alone,while 22 other types of cancers(66.7%)were detected by both mammography and ultrasound images.More than half of the cancers at stage 0 and I were detected in both the ultrasound group(66.7%,4/6)and combined group(66.7%,22/33),respectively,and the difference of proportion between the two groups was not significant(P=0.507).The results of this study suggest that the SYSU strategy is a suitable and alternative method for screening breast cancers in Southern Chinese women.