背景:过去四十年的大量研究表明,乳腺癌筛查(BCS)可显著降低乳腺癌(BC)死亡率。然而,在金砖国家,BCS和BC病死率和致残率之间的关联未知.本研究探讨了不同BCS方法与年龄标准化死亡率的关系。病死率,和残疾调整寿命年(DALYs)率,以及其他生物和社会人口统计学风险变量,从国家和经济的角度来看,跨越金砖国家。
方法:在这项生态研究中,应用混合效应多级回归模型,通过结合2019年全球疾病负担研究关于女性年龄标准化BC死亡率的数据,分析了特定国家的数据集,发病率,和DALYs比率以及有关国家/地区BCS可用性的信息(没有此类计划或仅试点计划)和BCS类型(仅自我乳房检查(SBE)和/或临床乳房检查(CBE)[SBE/CBE]与具有乳房X线摄影筛查可用性的SBE/CBE[MM和/或SBE/CBE]与具有先前数字乳房X线摄影和/超声检查的SBE/CBE/CBE
结果:与金砖国家的自我/临床乳房检查(SBE/CBE)相比,更复杂的BCS计划可用性是死亡率降低的最显著预测因素[MM和/或SBE/CBE:-2.64,p<0.001;DMM/US和/或既往检验:-1.40,p<0.001].在金砖国家,CVD的存在,高BMI,二手烟,和积极吸烟都导致BC死亡率和DALY率增加。金砖国家的高收入和中等收入地区的年龄标准化BC死亡率显着降低,病死率,在实施全国BC筛查计划时,DALYs比率高于低收入地区。
结论:在金砖国家,乳腺X线照相术(数字或传统)和BCS的可用性与乳腺癌负担有关,区域差异。根据先前因果研究的高质量证据,这些发现进一步支持了国家层面乳腺X线摄影筛查BCS的预防作用.干预BCS相关危险因素可进一步降低与BC相关的疾病负担。
Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC
case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality,
case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective.
In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries.
Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality,
case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented.
The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.