Aim: The aim of this study was to determine whether women at risk of having screen-detected (including detected at advanced stage) and interval breast cancer can be accurately identified using conventional risk factors collected by national screening programs. Methods: All 1,026,137 mammography screening examinations for 323,082 women attending the BreastScreen Western Australia program (part of Australia’s national biennial screening program) in July 2007–June 2017 contributed to models for predicting screen-detected breast cancers, screen-detected advanced cancers (≥pT2), and interval cancers. Results: In total, 7024 screen-detected (1551 in situ, 5472 invasive, of which 1329 were ≥pT2) and 1866 interval cancers (76 in situ, 1790 invasive) were diagnosed. In a multivariable model for screen-detected cancers, the ORs for the oldest age groups were 2.56 (CI 2.32–2.82) for 60–69 years and 3.60 (CI 3.23–4.00) for ≥70 years, and the OR for symptoms was 7.44 (CI 6.76–8.20). These associations were stronger for screen-detected advanced cancers. First-degree family history and a personal history of breast cancer were also associated with risk. In a multivariable model for interval cancers, the HR for dense breasts was 2.36 (CI 2.14–2.61) and the HR for symptoms was 3.27 (CI 2.53–4.24); family history and recent hormone replacement therapy use were also associated with risk. The areas under the receiver operating characteristic curves were 0.643 (CI 0.636–0.650) for screen-detected cancers, 0.651 (CI 0.638–0.664) for screen-detected advanced cancers, and 0.706 (CI 0.690–0.722) for interval cancers. Conclusion: Older age and symptoms were the strongest predictors of overall and advanced screen-detected breast cancers. Dense breasts and symptoms were the strongest predictors of interval cancers. All models had moderate discrimination, approximating that for established models.
目的：本研究旨在探讨能否利用国家筛查项目收集的常规风险因素，准确识别出具有筛查检出（包括晚期检出）及间期乳腺癌风险的女性。方法：纳入2007年7月至2017年6月期间参与西澳大利亚乳腺筛查项目（澳大利亚全国性两年期筛查项目组成部分）的323,082名女性共计1,026,137次乳腺X线筛查数据，构建预测筛查检出乳腺癌、筛查检出晚期癌症（≥pT2）及间期癌症的模型。结果：共诊断出7024例筛查检出癌（1551例原位癌，5472例浸润癌，其中1329例为≥pT2期）和1866例间期癌（76例原位癌，1790例浸润癌）。在筛查检出癌的多变量模型中，60-69岁年龄组的OR值为2.56（CI 2.32-2.82），≥70岁年龄组为3.60（CI 3.23-4.00），存在临床症状的OR值为7.44（CI 6.76-8.20）。这些关联性在筛查检出晚期癌症中更为显著。一级家族史和个人乳腺癌病史也与风险相关。在间期癌的多变量模型中，致密乳腺的HR值为2.36（CI 2.14-2.61），存在临床症状的HR值为3.27（CI 2.53-4.24）；家族史和近期激素替代疗法使用也与风险相关。受试者工作特征曲线下面积分别为：筛查检出癌0.643（CI 0.636-0.650），筛查检出晚期癌0.651（CI 0.638-0.664），间期癌0.706（CI 0.690-0.722）。结论：高龄和临床症状是筛查检出乳腺癌（包括晚期癌）的最强预测因素，而致密乳腺和临床症状是间期癌的最强预测因素。所有模型均具有中等区分度，与现有成熟模型的预测效能相近。
肿瘤(癌症)患者之家