乳腺癌筛查假阳性女性长期风险高

　　乳腺癌筛查假阳性，即乳腺钼靶筛查结果可疑，但是进一步检查并未确诊乳腺癌。不过，对于筛查结果假阳性女性，并非高枕无忧，仍然存在下次筛查时发现乳腺癌或下次筛查前发生乳腺癌（筛查间期乳腺癌）的风险。

　　2018年12月19日，英国癌症研究基金会和英国《自然》旗下《英国癌症杂志》在线发表西班牙巴塞罗那医学研究所、慢性疾病医疗服务网络、挪威癌症登记中心、奥斯陆大学学院、丹麦哥本哈根大学的三国人群联合分析研究报告，评定了第一次或第二次筛查结果假阳性女性随后筛查发现乳腺癌和筛查间期乳腺癌的长期风险。

　　该研究对欧洲三国（丹麦、挪威、西班牙）人群筛查项目的个体数据进行联合分析，其中包括114万9467位50～69岁已筛查女性：丹麦7万5513例（1991～2010年）、挪威55万6640例（1996～2008年）、西班牙51万7314例（1994～2010年）。通过部分条件多因素比例风险回归模型，对筛查结果假阳性与随后筛查发现乳腺癌和筛查间期乳腺癌风险之间的相关性进行评定。

　　结果，随访期间，114万9467例女性共接受了351万0450次筛查，其中筛查发现乳腺癌1万0623例、筛查间期乳腺癌5700例。

　　筛查结果假阳性与阴性女性相比：

• 筛查发现乳腺癌风险超两倍（风险比：2.04，95%置信区间：1.93～2.16）

• 筛查间期乳腺癌风险超两倍（风险比：2.18，95%置信区间：2.02～2.34）

　　第二次筛查结果假阳性与阴性女性相比：

• 筛查发现乳腺癌风险近五倍（风险比：4.71，95%置信区间：3.81～5.83）

• 筛查间期乳腺癌风险超四倍（风险比：4.22，95%置信区间：3.27～5.46）

　　筛查结果假阳性女性的乳腺癌风险保持12年居高不下。

　　因此，该研究结果表明，对于既往筛查结果假阳性的女性，筛查发现乳腺癌、筛查间期乳腺癌的风险增加可达十几年，故应根据个人风险设计个体化筛查方案。

Br J Cancer. 2018 Dec 19. [Epub ahead of print]

Long-term risk of screen-detected and interval breast cancer after false-positive results at mammography screening: joint analysis of three national cohorts.

Marta Román, Solveig Hofvind, My von Euler-Chelpin, Xavier Castells.

IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Cancer Registry of Norway, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Oslo, Norway; University of Copenhagen, Copenhagen, Denmark.

BACKGROUND: We assessed the long-term risk of screen-detected and interval breast cancer in women with a first or second false-positive screening result.

METHODS: Joint analysis had been performed using individual-level data from three population-based screening programs in Europe (Copenhagen in Denmark, Norway, and Spain). Overall, 75,513 screened women aged 50-69 years from Denmark (1991-2010), 556,640 from Norway (1996-2008), and 517,314 from Spain (1994-2010) were included. We used partly conditional Cox hazards models to assess the association between false-positive results and the risk of subsequent screen-detected and interval cancer.

RESULTS: During follow-up, 1,149,467 women underwent 3,510,450 screening exams, and 10,623 screen-detected and 5700 interval cancers were diagnosed. Compared to women with negative tests, those with false-positive results had a two-fold risk of screen-detected (HR = 2.04, 95% CI: 1.93-2.16) and interval cancer (HR = 2.18, 95% CI: 2.02-2.34). Women with a second false-positive result had over a four-fold risk of screen-detected and interval cancer (HR = 4.71, 95% CI: 3.81-5.83 and HR = 4.22, 95% CI: 3.27-5.46, respectively). Women remained at an elevated risk for 12 years after the false-positive result.

CONCLUSIONS: Women with prior false-positive results had an increased risk of screen-detected and interval cancer for over a decade. This information should be considered to design personalised screening strategies based on individual risk.

DOI: 10.1038/s41416-018-0358-5