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首页> 外文期刊>BMC Medical Informatics and Decision Making >What is the point: will screening mammography save my life?
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What is the point: will screening mammography save my life?

机译：重点是什么：乳腺钼靶筛查能否挽救我的生命？

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Background We analyzed the claim "mammography saves lives" by calculating the life-saving absolute benefit of screening mammography in reducing breast cancer mortality in women ages 40 to 65. Methods To calculate the absolute benefit, we first estimated the screen-free absolute death risk from breast cancer by adjusting the Surveillance, Epidemiology and End Results Program 15-year cumulative breast cancer mortality to account for the separate effects of screening mammography and improved therapy. We calculated the absolute risk reduction (reduction in absolute death risk), the number needed to screen assuming repeated screening, and the survival percentages without and with screening. We varied the relative risk reduction from 10%–30% based on the randomized trials of screening mammography. We developed additional variations of the absolute risk reduction for a screening intervention, including the average benefit of a single screen, as well as the life-saving proportion among patients with earlier cancer detection. Results Because the screen-free absolute death risk is approximately 1% overall but rises with age, the relative risk reduction from repeated screening mammography is about 100 times the absolute risk reduction between the starting ages of 50 and 60. Assuming a base case 20% relative risk reduction, repeated screening starting at age 50 saves about 1.8 (overall range, 0.9–2.7) lives over 15 years for every 1000 women screened. The number needed to screen repeatedly is 1000/1.8, or 570. The survival percentage is 99.12% without and 99.29% with screening. The average benefit of a single screening mammogram is 0.034%, or 2970 women must be screened once to save one life. Mammography saves 4.3% of screen-detectable cancer patients' lives starting at age 50. This means 23 cancers must be found starting at age 50, or 27 cancers at age 40 and 21 cancers at age 65, to save one life. Conclusion The life-saving absolute benefit of screening mammography increases with age as the absolute death risk increases. The number of events needed to save one life varies depending on the prospective screening subset or reference class. Less than 5% of women with screen-detectable cancers have their lives saved.
机译：背景我们通过计算筛查X线摄影对降低40至65岁女性乳腺癌死亡率的挽救生命的绝对收益，分析了“乳房X线摄影可以挽救生命”的说法。方法为了计算绝对收益，我们首先估算了无筛查的绝对死亡风险。通过调整“监测，流行病学和最终结果计划”，从乳腺癌中分离出15年的累积乳腺癌死亡率，以说明乳房X线照片筛查和改善治疗的单独作用。我们计算了绝对风险降低（绝对死亡风险的降低），假设进行重复筛查所需的筛查次数以及不进行筛查和采用筛查的存活率。根据乳腺X线摄影筛查的随机试验，我们将相对风险降低幅度从10％到30％不等。我们开发了筛查干预措施的绝对风险降低的其他变化，包括单次筛查的平均收益以及早期癌症检测患者中挽救生命的比例。结果由于无筛查的绝对死亡风险总体上约为1％，但随着年龄的增长而增加，因此，从50到60岁的初始年龄之间，重复筛查乳房X线照相术的相对风险降低约为绝对风险降低的100倍。假设基本情况为20％相对降低风险，从50岁开始进行重复筛查，每1000名筛查的妇女在15年内可节省约1.8（总体范围为0.9-2.7）生命。重复筛选所需的数字是1000 / 1.8，即570。不进行筛选的生存率为99.12％，经筛选的生存率为99.29％。一次乳房X线检查的平均收益为0.034％，否则必须对2970名妇女进行一次筛查以挽救一条生命。乳腺X射线摄影可挽救从50岁开始可筛查的癌症患者的生命，这一数字可节省4.3％。这意味着必须挽救50岁开始的23种癌症，或40岁时的27种癌症和65岁时的21种癌症，以挽救一条生命。结论随着绝对死亡风险的增加，筛查乳房X线照相术可以挽救生命的绝对利益随着年龄的增长而增加。挽救一条生命所需的事件数量因前瞻性筛查子集或参考类别而异。患有可筛查癌症的妇女中，只有不到5％挽救了生命。

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