多瘤别癌症风险评估工具对乳腺癌筛查行为的影响

Study on the impact of cancer risk assessment tools for multiple cancer on breast cancer screening behavior

目的探讨多瘤别癌症风险评估工具对社区女性乳腺癌筛查行为的影响。方法以2018年5月-2020年5月参与社区居民癌症筛查与早发现管理项目的上海市近郊2个社区共计10326名女性居民为研究对象,采用自身前后对照的研究方法,比较总体和不同特征对象在风险评估前后乳腺癌筛查行为的变化。采用配对χ^(2)检验对癌症风险评估前后筛查参与率进行比较,以逐步前进法对评估前后筛查参与率的影响因素进行多因素logistic回归分析,并通过皮尔森χ^(2)检验或Fisher确切概率法比较评估后筛查参与者中新增筛查者与非新增筛查者、评估后新增筛查者与评估前筛查者的人群特征差异。结果研究对象风险评估前2年内和评估后2年内的乳腺癌筛查参与率分别为3.07%(317/10326)和2.61%(269/10326)。评估后参加筛查的对象中,新增者占93.31%(251/269)。文化程度、家庭人均月收入、一级亲属癌症家族史和乳腺相关症状史等评估前筛查参与率的影响因素对评估后筛查参与率不再有影响;评估后筛查参与者中,无一级亲属癌症家族史、无二级亲属癌症家族史、无乳腺癌相关疾病史和乳腺癌中低风险者是新增筛查的可能性分别是有一级亲属癌症家族史、有二级亲属癌症家族史、有乳腺相关疾病史和乳腺癌高危风险者的1.818、3.377、2.444、2.185和2.031倍。结论癌症风险评估工具可能促进不具有乳腺癌相关危险因素的、之前未筛查过的一般人群参加筛查。

Objective To investigate the impact of cancer risk assessment tools on the breast cancer screening behavior of female residents in communities.Methods Totally 10326 female residents in two communities in the suburbs of Shanghai who participated in the cancer screening and early detection management projects between May 2018 to May 2020 were se-lected as the research subjects.The study used a self-contrasting method to compare the screening behaviors before and after risk assessment in the overall population and in subjects with different characteristics.Paired chi-square tests were used to compare participation rates in cancer risk assessment before and after screening.Factors influencing pre-and post-assessment screening participation rates were analyzed using multivariate logistic regression with the stepwise forward method.Pearson's chi-squared test was used to compare population characteristics of newly screened and non-newly screened individuals after the assessment,and of newly screeners and pre-assessment screeners.Results The mammogra-phy rates,before and after the risk assessment,in the study population were 3.07%(317/10326)and 2.61%(269/10326),respectively.Of those who participated in screening after risk assessment,93.31%(251/269)were newly screened.After risk assessment,factors such as literacy,income,family history of cancer in first-degree relatives,and history of breast-related symptoms no longer influenced the screening participation rates.Among those screened after as-sessment,individuals with no family history of cancer in a first-degree relative,no family history of cancer in a second-de-gree relative,no history of breast cancer-related disease,and those at intermediate to low risk of breast cancer were 1.818,3.377,2.444,2.185,and 2.031 times more likely to be newly screened than those with a family history of cancer in a first-degree relative,a family history of cancer in a second-degree relative,a history of breast-related diseases,and those at high risk of breast cancer,respectively.Conclusion The cancer risk assessment tool may promote screening par-ticipation among the general population who do not have risk factors for breast cancer and who have not previously been screened.