25-乳腺癌筛查的过度诊断率：Malmo乳腺X 线筛查试验随访15年的结果.pdf
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论著
De partment of
Clinical Scienc es
in Malm ,Epidemiologic al
Re sea rch Group,Lund Univers i ty,Ma lmUnivers ity
Hospi tal , SE-205 02,Ma lm , Sweden
Sophia Zackris son,doctor
Lar s Ja nzon,professor
Jonas Manje r,a ssocia te professor
Me dical Ra diology,Ma lmUnivers ity
Hospi tal
Ingvar Ande rsson,a ssocia te professor ,De partment of Surgery,Tar hus Unive rsi ty
Hospi tal ,DK 8000 Tarhus C,De nmark
Jens Peter Garne ,a ssocia te professor
Correspondence to:
S Zackris son
sophia. zackrisson @
med. lu. se
4 Ros s JS, Fletcher JA. The HER -2 / neu oncogene in brea st cance r: prognost ic
fac tor, pre dic tive factor , and target for the rapy. Stem Cel ls 1998 ; 16: 413-28.
5 Bonadonna G, Valagussa P, Mol iter ni A, Zambet ti M, Brambi l la C. Adjuvant
cyclophosphamide, m ethotr exate , and fluor ourac il in node -pos i tive brea st
cance r: the resul ts of 20 ye ars of fol low- up . N Engl J Med 1995 ; 332: 901-6.
6 Tancini G, Bonadonna G, Valagussa P , Ma rchini S, Verones i U. Adjuvant
CMF in br eas t canc er: c ompara tive 5 -ye ar re sul ts of 12 versus 6 c ycles . J Clin
Oncol 1983 ; 1 : 2 -10 .
7 Zambe tt i M, Bona donna G, Va lagussa P , Da idone MG, Cora dini D, Bignami
P, et al . Adjuvant CMF for node- nega tive and es tr oge n rece ptor -negat ive
br eas t c ancer . J Nat l Ca ncer Ins t Monogr 1992; 11 : 79 -85 .
8 Ja ke sz R , Hausmaninger H , Kubis ta E, Gnant M, Me nzel C , Ba uernhofer T,et al . R andomized adjuvant tr ia l of tamoxi fen a nd gosere lin ver sus
cyclophosphamide , methotr exa te , and fluorourac il : e vide nce for the superiori ty
of t rea tme nt wi th endocr ine blockade in premenopa usa l pat ie nts with hormone -
respons ive breas t cance r - Aus t ria n Br eas t a nd Colorectal Cance r Study Group
trial 5. J Clin Oncol 2002 ; 20: 4621-7.
9 Jona t W, Kaufmann M, Sa uerbrei W, Blame y R , Cuzic k J , Namer M, et al .
Goser el in versus cyclophosphamide , methot rexate, and fluorour aci l as adjuvant
ther apy in pr emenopa usa l pat ients wi th node- pos it ive bre as t cance r: the
Zoladex e arly breas t c ance r re se arch as sociat ion s tudy. J Cl in Oncol 2002; 20:
4628-35.
10 Ea rly Br eas t Canc er Trial ists′Col labora tive Group. Tamoxi fe n for ea rly brea st
cance r: a n overvie w of the ra ndomised t ria ls . Lancet 1998; 351: 1451 -67 .
11 Mé na rd S, Valagussa P , Pi lot ti S , Gianni L, Biganzol i E, Boracc hi P, et al .
Response to CMF in lymph-node pos it ive bre as t c ance r acc ording to H ER2
over expre ss ion and other tumour s biologic variables . J Cl in Oncol 2001; 19:
329-35.
BMJ 2005; 330 : 217-20
乳腺癌筛查的过度诊断率:Malm乳腺 X 线筛查试验
随访 15 年的结果
Rate of over-diagnosis of breast cancer 15 years af ter end of
M almmammographic screening trial: follow-up study
Sophia Zackrisson, Ingvar Andersson, Lars Janzon, Jona s Manjer, Jens P eter Garne
摘要
目的: 根据Malm 乳腺 X 线筛查试验随访15
年的资料评价乳腺癌的过度诊断率。
设计:随访资料研究。
机构:Malm , 瑞典。
研究对象: 42 283 例随机入组时45 ～ 69 岁的
妇女。
干预:分为接受乳腺 X 线筛查和不接受筛查
组( 对照组) 。随机试验结束后, 45 ～ 54 岁年龄段
的筛查组和对照组妇女均接受筛查, 55 ～ 69 岁年
龄段的两个组妇女则不接受筛查。
主要方法: 在随机试验进行过程中( 第一阶
段) ,随机试验结束后( 第二阶段) 以及随访结束
时分析筛查组和对照组乳腺癌过度诊断的发生
率。
结果:对于年龄 55 ～ 69 岁的妇女, 乳腺癌过
度诊断的相对发生率( 95% 的可信区间) 在第一
阶段为 1. 32( 1. 14 比 1. 530) , 第二阶段为 0. 92
( 0. 79 比 1. 06 ) , 随访结束时为 1. 10 ( 0. 99 比
1. 22) ......
De partment of
Clinical Scienc es
in Malm ,Epidemiologic al
Re sea rch Group,Lund Univers i ty,Ma lmUnivers ity
Hospi tal , SE-205 02,Ma lm , Sweden
Sophia Zackris son,doctor
Lar s Ja nzon,professor
Jonas Manje r,a ssocia te professor
Me dical Ra diology,Ma lmUnivers ity
Hospi tal
Ingvar Ande rsson,a ssocia te professor ,De partment of Surgery,Tar hus Unive rsi ty
Hospi tal ,DK 8000 Tarhus C,De nmark
Jens Peter Garne ,a ssocia te professor
Correspondence to:
S Zackris son
sophia. zackrisson @
med. lu. se
4 Ros s JS, Fletcher JA. The HER -2 / neu oncogene in brea st cance r: prognost ic
fac tor, pre dic tive factor , and target for the rapy. Stem Cel ls 1998 ; 16: 413-28.
5 Bonadonna G, Valagussa P, Mol iter ni A, Zambet ti M, Brambi l la C. Adjuvant
cyclophosphamide, m ethotr exate , and fluor ourac il in node -pos i tive brea st
cance r: the resul ts of 20 ye ars of fol low- up . N Engl J Med 1995 ; 332: 901-6.
6 Tancini G, Bonadonna G, Valagussa P , Ma rchini S, Verones i U. Adjuvant
CMF in br eas t canc er: c ompara tive 5 -ye ar re sul ts of 12 versus 6 c ycles . J Clin
Oncol 1983 ; 1 : 2 -10 .
7 Zambe tt i M, Bona donna G, Va lagussa P , Da idone MG, Cora dini D, Bignami
P, et al . Adjuvant CMF for node- nega tive and es tr oge n rece ptor -negat ive
br eas t c ancer . J Nat l Ca ncer Ins t Monogr 1992; 11 : 79 -85 .
8 Ja ke sz R , Hausmaninger H , Kubis ta E, Gnant M, Me nzel C , Ba uernhofer T,et al . R andomized adjuvant tr ia l of tamoxi fen a nd gosere lin ver sus
cyclophosphamide , methotr exa te , and fluorourac il : e vide nce for the superiori ty
of t rea tme nt wi th endocr ine blockade in premenopa usa l pat ie nts with hormone -
respons ive breas t cance r - Aus t ria n Br eas t a nd Colorectal Cance r Study Group
trial 5. J Clin Oncol 2002 ; 20: 4621-7.
9 Jona t W, Kaufmann M, Sa uerbrei W, Blame y R , Cuzic k J , Namer M, et al .
Goser el in versus cyclophosphamide , methot rexate, and fluorour aci l as adjuvant
ther apy in pr emenopa usa l pat ients wi th node- pos it ive bre as t cance r: the
Zoladex e arly breas t c ance r re se arch as sociat ion s tudy. J Cl in Oncol 2002; 20:
4628-35.
10 Ea rly Br eas t Canc er Trial ists′Col labora tive Group. Tamoxi fe n for ea rly brea st
cance r: a n overvie w of the ra ndomised t ria ls . Lancet 1998; 351: 1451 -67 .
11 Mé na rd S, Valagussa P , Pi lot ti S , Gianni L, Biganzol i E, Boracc hi P, et al .
Response to CMF in lymph-node pos it ive bre as t c ance r acc ording to H ER2
over expre ss ion and other tumour s biologic variables . J Cl in Oncol 2001; 19:
329-35.
BMJ 2005; 330 : 217-20
乳腺癌筛查的过度诊断率:Malm乳腺 X 线筛查试验
随访 15 年的结果
Rate of over-diagnosis of breast cancer 15 years af ter end of
M almmammographic screening trial: follow-up study
Sophia Zackrisson, Ingvar Andersson, Lars Janzon, Jona s Manjer, Jens P eter Garne
摘要
目的: 根据Malm 乳腺 X 线筛查试验随访15
年的资料评价乳腺癌的过度诊断率。
设计:随访资料研究。
机构:Malm , 瑞典。
研究对象: 42 283 例随机入组时45 ～ 69 岁的
妇女。
干预:分为接受乳腺 X 线筛查和不接受筛查
组( 对照组) 。随机试验结束后, 45 ～ 54 岁年龄段
的筛查组和对照组妇女均接受筛查, 55 ～ 69 岁年
龄段的两个组妇女则不接受筛查。
主要方法: 在随机试验进行过程中( 第一阶
段) ,随机试验结束后( 第二阶段) 以及随访结束
时分析筛查组和对照组乳腺癌过度诊断的发生
率。
结果:对于年龄 55 ～ 69 岁的妇女, 乳腺癌过
度诊断的相对发生率( 95% 的可信区间) 在第一
阶段为 1. 32( 1. 14 比 1. 530) , 第二阶段为 0. 92
( 0. 79 比 1. 06 ) , 随访结束时为 1. 10 ( 0. 99 比
1. 22) ......
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