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对女性人群推广有效的乳腺摄片筛查，应该能够影响乳腺癌发病率、年龄和分期相关乳腺癌发病率以及乳腺癌死亡率。因此，德国于2005年开始向全国50～69岁女性推广每2年1次的乳腺摄片筛查。 2019年12月4日，国际抗癌联盟《国际癌症杂志》在线发表德国吕贝克大学、罗伯特科赫研究院、德国癌症登记数据中心的研究报告，对德国乳腺摄片筛查推广前后10年内的乳腺癌发病率和乳腺癌死亡率进行了比较。 该研究对2003～2014年覆盖3000万居民的指定地区32万3719例乳腺癌患者数据以及1998～2016年几乎整个德国的官方死亡数据进行回顾分析。对2003～2004年筛查推广前与2013～2014、2015～2016年筛查推广后的乳腺癌发病率和乳腺癌死亡率进行比较，并且通过连接点回归模型进行趋势分析。 结果发现，对于50～59岁和60～69岁筛查年龄组，随着乳腺摄片筛查逐步推广，乳腺癌发病率出现典型患病高峰，主要由于早期乳腺癌增加所致。 2013～2014年与筛查筛查推广前相比，III期、IV期乳腺癌发病率：
2015～2016年与2003～2004年相比，乳腺癌死亡率：
因此，该研究结果表明，由于未筛查年龄组的相应变化趋势显著不利，故德国筛查年龄组的晚期乳腺癌发病率和乳腺癌死亡率减少，最有可能归因于全国乳腺摄片筛查的推广。这些积极影响的代价是乳腺癌过度诊断的缓慢增加，尤其乳腺原位癌的急剧增加。 相关阅读 Int J Cancer. 2019 Dec 4. [Epub ahead of print] Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Katalinic A, Eisemann N, Kraywinkel K, Noftz MR, Hübner J. University of Lübeck, Lübeck, Germany; German Centre for Cancer Registry Data, Robert Koch-Institute, Berlin, Germany. What's new? Effective mammography screening should have an impact on breast cancer (BC) incidence and mortality. Until today, however, there is little information available on the population-based outcomes of the national breast cancer screening program in Germany. Here, the authors present age-specific population-based data before and after implementation of the program. Compared to non-exposed age groups, screening-eligible women showed more favorable trends regarding the incidence of late-stage BC and BC mortality. A persistent excess of BC incidence, mainly driven by an increase of in situ cancers, indicated a moderate amount of overdiagnosis. Effective population-based mammography screening should impact breast cancer (BC) incidence, age and stage-specific incidence and BC mortality. We aim to investigate such effects in a time period of 10 years after implementation of the German mammography screening program. Data on 323,719 breast cancer patients from 2003 to 2014 for defined regions covering a population of 30 million inhabitants and official mortality data from 1998 to 2016 for almost the whole of Germany were used. We compared incidence and mortality rates for the prescreening time period (2003/2004) and the latest available data (2013/2014 and 2015/2016, respectively) and performed trend analyses using joinpoint regression models. In the screening exposed age groups (50-59 and 60-69 years), BC incidence showed a typical prevalence peak with the introduction of the mammography screening, mainly driven by an increase of early-stage BC. For Stage III and IV BC incidence in 2013/2014 was 24.2 and 23.0% (age group 50-59 years) and 28.3 and 24.2% (age group 60-69 years) lower than in the prescreening period. From 2003/2004 to 2015/2016 BC mortality decreased by 25.8 and 21.2%, respectively. As corresponding trends in nonexposed age groups were distinctly unfavorable, the reduction of late-stage BC incidence and BC mortality in the screening exposed age groups in Germany is most likely to be attributed to the introduction of the national mammography screening program. These positive effects are bought at the cost of a moderate occurrence of overdiagnosis, especially by a sharp increase of in situ cancers. KEYWORDS: breast cancer; incidence; mortality; mammography screening PMID: 31675126 DOI: 10.1002/ijc.32767
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