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乳腺摄片筛查发现异常后，复诊延迟可能引起不良结局。 2017年6月12日，美国癌症学会《癌症》杂志在线发表旧金山加利福尼亚大学、戴维斯加利福尼亚大学、旧金山退伍军人医疗中心的研究报告，调查了乳腺摄片筛查发现异常后，亚裔与非西班牙裔白人女性、不同种族亚裔女性之间复诊时间的不同。 该前瞻队列研究入组2000～2010年在旧金山乳腺摄片登记中心（SFMR）乳腺成像、报告和数据系统（BI-RADS）发现异常（0或≥3类）的非西班牙裔白人和亚裔女性共50970例，使用卡普兰迈尔曲线估算从筛查至复诊（通过放射学检查确诊）的中位天数，对30、60、90天复诊和1年未复诊的亚裔（以及不同种族亚裔）女性和非西班牙裔白人女性比例进行比较。此外，使用多变量校正比例风险模型，对不同种族与复诊时间的相关性进行评定。 结果发现，亚裔与非西班牙裔白人女性相比：
因此，亚裔（尤其菲律宾裔和越南裔）与非西班牙裔白人女性相比，乳腺摄片筛查发现异常后复诊较不及时。进一步研究应解析不同种族的亚裔女性，深入了解并解决有效预防癌症的障碍。 Cancer. 2017 Jun 12. [Epub ahead of print] Disparities in abnormal mammogram follow-up time for Asian women compared with non-Hispanic white women and between Asian ethnic groups. Nguyen KH, Pasick RJ, Stewart SL, Kerlikowske K, Karliner LS. University of California at San Francisco, San Francisco, California; University of California at Davis, Davis, California; San Francisco Veteran Affairs Medical Center, San Francisco, California. BACKGROUND: Delays in abnormal mammogram follow-up contribute to poor outcomes. In the current study, the authors examined differences in abnormal screening mammogram follow-up between non-Hispanic white (NHW) and Asian women. METHODS: The authors used a prospective cohort of NHW and Asian women with a Breast Imaging, Reporting and Data System (BI-RADS) abnormal result of category 0 or 3-plus in the San Francisco Mammography Registry between 2000 and 2010. Kaplan-Meier estimation for the median number of days to follow-up with a diagnostic radiologic test was performed, and the authors compared the percentage of women with follow-up at 30 days, 60 days, and 90 days and no follow-up at 1 year for Asian women overall (and Asian ethnic groups) and NHW women. In addition, the authors assessed the relationship between race/ethnicity and time to follow-up with adjusted Cox proportional hazards models. RESULTS: Among Asian women, Vietnamese and Filipina women had the longest, and Japanese women the shortest, median follow-up (32 days, 28 days, and 19 days, respectively) compared with NHW women (15 days). The percentage of women receiving follow-up at 30 days was lower for Asians versus NHWs (57% vs 77%; P<.0001), and these disparities persisted at 60 days and 90 days for all Asian ethnic groups except Japanese. Asian women had a reduced hazard of follow-up compared with NHW women (adjusted hazard ratio, 0.70; 95% confidence interval, 0.69-0.72). Asian women also had a higher rate of receiving no follow-up compared with NHW women (15% vs 10%; P<.001); among Asian ethnic groups, Filipinas were found to have the highest percentage of women with no follow-up (18.1%). CONCLUSIONS: Asian women, particularly Filipina and Vietnamese women, were less likely than NHW women to receive timely follow-up after an abnormal screening mammogram. Research should disaggregate Asian ethnicity to better understand and address barriers to effective cancer prevention. KEYWORDS: Asian; abnormal mammogram; breast cancer; ethnicity; health care disparity PMID: 28603859 DOI: 10.1002/cncr.30756 |
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