PDF(Pubmed)
Abstract：
This study aimed to identify predictors of nonadherence to breast cancer screening guidelines in an urban screening clinic among high- and average-risk women in the United States.
We reviewed records of 6090 women who received ≥2 screening mammograms over 2 years at the Karmanos Cancer Institute to examine how breast cancer risk and breast density were associated with guideline-concordant screening. Incongruent screening was defined as receiving supplemental imaging between screening mammograms for average-risk women, and as not receiving recommended supplemental imaging for high-risk women. We used t-tests and chi-square tests to examine bivariate associations with guideline-congruent screening, and probit regression to regress guideline-congruence unto breast cancer risk, breast density, and their interaction, controlling for age and race.
Incongruent screening was more likely among high- versus average-risk women (97.7% vs. 0.9%, p < 0.01). Among average-risk women, incongruent screening was more likely among those with dense versus nondense breasts (2.0% vs. 0.1%, p < 0.01). Among high-risk women, incongruent screening was more likely among those with nondense versus dense breasts (99.5% vs. 95.2%, p < 0.01). The significant main effects of density and high-risk on increased incongruent screening were qualified by a density by high-risk interaction, showing a weaker association between risk and incongruent screening among women with dense breasts (simple slope = 3.71, p < 0.01) versus nondense breasts (simple slope = 5.79, p < 0.01). Age and race were not associated with incongruent screening.
Lack of adherence to evidence-based screening guidelines has led to underutilization of supplementary imaging for high-risk women and potential overutilization for women with dense breasts without other risk factors.
We reviewed records of 6090 women who received ≥2 screening mammograms over 2 years at the Karmanos Cancer Institute to examine how breast cancer risk and breast density were associated with guideline-concordant screening. Incongruent screening was defined as receiving supplemental imaging between screening mammograms for average-risk women, and as not receiving recommended supplemental imaging for high-risk women. We used t-tests and chi-square tests to examine bivariate associations with guideline-congruent screening, and probit regression to regress guideline-congruence unto breast cancer risk, breast density, and their interaction, controlling for age and race.
Incongruent screening was more likely among high- versus average-risk women (97.7% vs. 0.9%, p < 0.01). Among average-risk women, incongruent screening was more likely among those with dense versus nondense breasts (2.0% vs. 0.1%, p < 0.01). Among high-risk women, incongruent screening was more likely among those with nondense versus dense breasts (99.5% vs. 95.2%, p < 0.01). The significant main effects of density and high-risk on increased incongruent screening were qualified by a density by high-risk interaction, showing a weaker association between risk and incongruent screening among women with dense breasts (simple slope = 3.71, p < 0.01) versus nondense breasts (simple slope = 5.79, p < 0.01). Age and race were not associated with incongruent screening.
Lack of adherence to evidence-based screening guidelines has led to underutilization of supplementary imaging for high-risk women and potential overutilization for women with dense breasts without other risk factors.
摘要：
背景：本研究旨在确定美国高危和平均风险女性在城市筛查诊所不遵守乳腺癌筛查指南的预测因素。
方法：我们回顾了在Karmanos癌症研究所接受2年以上乳房X线检查的6090名女性的记录，以检查乳腺癌风险和乳腺密度与指南一致筛查的相关性。不一致筛查被定义为在平均风险女性的乳房X光检查之间接受补充成像。以及未接受高危女性推荐的补充影像学检查。我们使用t检验和卡方检验来检验与指南一致筛选的双变量关联，和probit回归到乳腺癌风险的指南一致性，乳腺密度,和他们的互动，控制年龄和种族。
结果：高风险女性与平均风险女性相比，不一致筛查的可能性更大（97.7%与0.9%，p<0.01)。在平均风险的女性中，在乳房致密和乳房不致密的患者中，不一致筛查的可能性更大(2.0%与0.1%,p<0.01)。在高危女性中,在乳房不致密和致密的患者中，不一致筛查的可能性更大(99.5%与95.2%,p<0.01)。密度和高风险对不一致筛查增加的显着主要影响通过高风险相互作用的密度来限定。在乳房致密的女性中（简单斜率=3.71，p<0.01）与乳房致密的女性（简单斜率=5.79，p<0.01）之间的风险和不一致筛查之间的关系较弱。年龄和种族与不一致的筛查无关。
结论：缺乏对循证筛查指南的坚持导致高危女性补充成像的利用不足，而没有其他危险因素的致密乳房女性可能过度使用。
方法：我们回顾了在Karmanos癌症研究所接受2年以上乳房X线检查的6090名女性的记录，以检查乳腺癌风险和乳腺密度与指南一致筛查的相关性。不一致筛查被定义为在平均风险女性的乳房X光检查之间接受补充成像。以及未接受高危女性推荐的补充影像学检查。我们使用t检验和卡方检验来检验与指南一致筛选的双变量关联，和probit回归到乳腺癌风险的指南一致性，乳腺密度,和他们的互动，控制年龄和种族。
结果：高风险女性与平均风险女性相比，不一致筛查的可能性更大（97.7%与0.9%，p<0.01)。在平均风险的女性中，在乳房致密和乳房不致密的患者中，不一致筛查的可能性更大(2.0%与0.1%,p<0.01)。在高危女性中,在乳房不致密和致密的患者中，不一致筛查的可能性更大(99.5%与95.2%,p<0.01)。密度和高风险对不一致筛查增加的显着主要影响通过高风险相互作用的密度来限定。在乳房致密的女性中（简单斜率=3.71，p<0.01）与乳房致密的女性（简单斜率=5.79，p<0.01）之间的风险和不一致筛查之间的关系较弱。年龄和种族与不一致的筛查无关。
结论：缺乏对循证筛查指南的坚持导致高危女性补充成像的利用不足，而没有其他危险因素的致密乳房女性可能过度使用。
