根据预期寿命使用乳腺摄片监测老年乳腺癌生存者

　　对于预期寿命有限的老年乳腺癌生存者，每年监测乳腺摄片的获益尚不明确，并且存在重大风险；然而，对于这些女性的乳腺摄片使用情况知之甚少。

　　2017年7月27日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表哈佛医学院、达纳法伯癌症研究所、布列根（医院）和（波士顿）妇女医院、贝斯以色列女执事医疗中心的研究报告，发现将近六成预期寿命较短的老年乳腺癌生存者每年监测乳腺摄片。

　　该研究使用2000、2005、2008、2010、2013、2015年国民健康问卷调查（NHIS）数据，对有乳腺癌史且年龄≥65岁女性的乳腺摄片监测使用情况进行分析。使用多变量逻辑回归，对预期寿命（根据绍恩伯格指数）为5年和10年者，评定最近12个月内乳腺摄片检查率，并根据调查年份、地区、年龄、婚姻状况、医疗保险、教育程度、医疗获取指标进行校正。

　　结果发现，共有1040例调查问卷反馈者符合条件，其中年龄≥80岁占33.7%，白人占88.6%，预期寿命≤5和≤10年者约占8.6%和35.1%。

　　总体而言，最近12个月内接受过常规监测乳腺摄片者占78.9%。虽然预期寿命为5年和10年者最近一年乳腺摄片接受率分别为56.7%和65.9%，但是乳腺摄片接受率随预期寿命降低而显著降低（P＜0.001）。相反，预期寿命＞10年者仅14.1%未接受乳腺摄片。

　　根据校正分析，较低与较高的预期寿命相比，乳腺摄片率显著较低：

• 预期寿命≤5年的比值比：0.4，95%置信区间：0.3～0.8

• 预期寿命≤10年的比值比：0.4，95%置信区间：0.3～0.6

　　综上所述，尽管获益不明，许多（56.7%）预期寿命较短（＜5年）的老年乳腺癌生存者每年监测乳腺摄片，而14.1%的预期寿命＞10年者未接受乳腺摄片，故需实践指南对老年患者的随访进行优化和个体化。

投票调查

J Clin Oncol. 2017 Jul 27. [Epub ahead of print]

Use of Surveillance Mammography Among Older Breast Cancer Survivors by Life Expectancy.

Freedman RA, Keating NL, Pace LE, Lii J, McCarthy EP, Schonberg MA.

Dana-Farber Cancer Institute; Harvard Medical School; Brigham and Women's Hospital; Beth Israel Deaconess Medical Center, Boston, MA.

PURPOSE: The benefits of annual surveillance mammography in older breast cancer survivors with limited life expectancy are not known, and there are important risks; however, little is known about mammography use among these women.

MATERIALS AND METHODS: We used National Health Interview Study data from 2000, 2005, 2008, 2010, 2013, and 2015 to examine surveillance mammography use among women age ≥ 65 years who reported a history of breast cancer. Using multivariable logistic regression, we assessed the probability of mammography within the last 12 months by 5- and 10-year life expectancy (using the validated Schonberg index), adjusting for survey year, region, age, marital status, insurance, educational attainment, and indicators of access to care.

RESULTS: Of 1,040 respondents, 33.7% were age ≥ 80 years and 88.6% were white. Approximately 8.6% and 35.1% had an estimated life expectancy of ≤ 5 and ≤ 10 years, respectively. Overall, 78.9% reported having routine surveillance mammography in the last 12 months. Receipt of mammography decreased with decreasing life expectancy (P < .001), although 56.7% and 65.9% of those with estimated ≤ 5-year and ≤ 10-year life expectancy, respectively, reported mammography in the last year. Conversely, 14.1% of those with life expectancy > 10 years did not report mammography. In adjusted analyses, lower (v higher) life expectancy was significantly associated with lower odds of mammography (odds ratio, 0.4; 95% CI, 0.3 to 0.8 for ≤ 5-year life expectancy and OR, 0.4; 95% CI, 0.3 to 0.6 for ≤ 10-year life expectancy).

CONCLUSION: Many (57%) older breast cancer survivors with an estimated short life expectancy (< 5 years) receive annual surveillance mammography despite unknown benefits, whereas 14% with estimated life expectancy > 10 years did not report mammography. Practice guidelines are needed to optimize and tailor follow-up care for older patients.

PMID: 28749724

DOI: 10.1200/JCO.2016.72.1209