Development and evaluation of the screening performance of a low-cost high-risk screening strategy for breast cancer

作     者：Yubei Huang Huan Wang Zhangyan Lyu Hongji Dai Peifang Liu Ying Zhu Fengju Song Kexin Chen Yubei Huang;Huan Wang;Zhangyan Lyu;Hongji Dai;Peifang Liu;Ying Zhu;Fengju Song;Kexin Chen

作者机构：Department of Cancer Epidemiology and Biostatistics2Department of Breast ImagingTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and Therapy of TianjinTianjin’s Clinical Research Center for CancerKey Laboratory of Cancer Molecular Epidemiology of TianjinKey Laboratory of Breast Cancer Prevention and TherapyMinistry of EducationTianjin 300060China 

出 版 物：《Cancer Biology & Medicine》 (癌症生物学与医学（英文版）)

年 卷 期：2022年第19卷第9期

页      面：1375-1384页

核心收录：

学科分类：1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 100214[医学-肿瘤学] 10[医学] 

基　　金：supported by the Chinese National Key Research and Development Project(Grant No.2018YFC1315601) the National Natural Science Foundation of China(Grant No.81974488) the Tianjin Science and Technology Committee Foundation(Grant Nos.18JCQNJC80300 and 17JCYBJC25300). 

主　　题：Cancer screening breast cancer high risk mammography ultrasonography 

摘      要：Objective:To develop and evaluate the screening performance of a low-cost high-risk screening strategy for breast cancer in low resource areas.Methods:Based on the Multi-modality Independent Screening Trial,6 questionnaire-based risk factors of breast cancer(age at menarche,age at menopause,age at first live birth,oral contraceptive,obesity,family history of breast cancer)were used to determine the women with high risk of breast cancer.The screening performance of clinical breast examination(CBE),breast ultrasonography(BUS),and mammography(MAM)were calculated and compared to determine the optimal screening method for these high risk women.Results:A total of 94 breast cancers were detected among 31,720 asymptomatic Chinese women aged 45–65 years.Due to significantly higher detection rates(DRs)and suitable coverage of the population,high risk women were defined as those with any of 6 risk factors.Among high risk women,the DR for BUS[3.09/1,000(33/10,694)]was similar to that for MAM[3.18/1,000(34/10,696)],while it was significantly higher than that for the CBE[1.73/1,000(19/10,959),P=0.002].Compared with MAM,BUS showed significantly higher specificity[98.64%(10,501/10,646)vs.98.06%(10,443/10,650),P=0.001],but no significant differences in sensitivity[68.75%(33/48)vs.73.91%(34/46)],positive prediction values[18.54%(33/178)vs.14.11%(34/241)],and negative prediction values[99.86%(10,501/10,516)vs.99.89%(10,443/10,455)].Further analyses showed no significant difference in the percentages of early stage breast cancer[53.57%(15/28)vs.50.00%(15/30)],lymph node involvement[22.73%(5/22)vs.28.00%(7/25)],and tumor size≥2 cm[37.04%(10/27)vs.29.03%(9/31)]between BUS and MAM.Subgroup analyses stratified by breast densities or age at enrollment showed similar results.Conclusions:The low-cost high-risk screening strategy based on 6 questionnaire-based risk factors was an easy-to-use method to identify women with high risk of breast cancer.Moreover,BUS and MAM had comparable screening performances among high risk women.