| ObjectiveBreast cancer is a common malignancy of women in many countries and regions,its incidence rate ranks first in female cancer.Although there is a low-incidence of breast cancer in China,but the rapid increase in recent years and the patient was getting younger and younger ages,particularly in some coastal cities,the incidence rate of breast cancer ranks first,and have become the most common female malignant causes of death.For the prevention and treatment of breast cancer,early diagnosis and early treatment will be accepted best method.As early as the 1970s and 1980s,many Western countries had been established national breast cancer screening project and carried on cost-effectiveness analysis,but so far there has not yet a fixed breast cancer screening program in China.The study refers to the comparison of several screening methods based on cost-effectiveness analysis and incremental cost-effectiveness analysis to reduce at reasonable breast cancer screening method for Chinese women,and same time for our government to develop the national breast cancer screening project as reference.MethodsA multi-center study of methods,was conducted in Tianjin,Nanchang,Shenyang Feicheng,and a totale of 22 960 women without clinical symptoms were asked to breast cancer screening for free.In this project,all the women were asked to conduct epidemiological investigation,clinical breast examination,breast ultrasound and mammography examination in turn.Doctor decided whether to recommend biopsy according to the various test results.When comparing the effect of screening:a total of 67 screen-detected and 1547 unscreened breast cancer patients enrolled in this study.All information was collected by questionnaire through face-to-face interview,which included demographic data,menstrual status,and disease history,family history of cancer,etc.At the same time,comparing the application value of inspection methods according to the population(21,597 women)of the three methods are accepted by check comparison of the application value.Using TreeAge decision analysis software to establish a breast cancer disease process model,breast cancer screening strategies will be integrated into the different models and input parameters to simulate the impact of breast cancer disease process on screening.Results(1)The proportion of ductal carcinoma in situ(DCIS)was 11.9%in the screen-detected cases and 7.3%in the unscreened patients(p=0.136).Screen-detected tumors were significantly more frequently earlier stage,lower histological grade,tumor size<20 mm,node-negative and non-metastasis compared to unscreened tumors(p=0.003,p=0.010,p=0.008,p=0.000 and p=0.004,respectively).(2)A total of 65 breast cancers including 57 invasive cancers and 8 DCIS,among 52 cases of early breast cancer were detected,accounting for 89.8%(52/59,6 cases unknown).Sensitivity,specificity,PPV and NPV of CBE,MAM,CBE and BUS,BUS and MAM,BUS,CBE and MAM were showed.(3)Our model showed that CER values of 12 screening strategies were ranged from 72498.62 to 153860.16 yuan/QALY.CBE and BUS biennial breast cancer screening fou women 35-69 years old age among the cost-effective programs producted the most QALY,which cost-effectiveness ratio was 80356.94 yuan/QALY.Conclusions1)This study suggests that breast cancers diagnosed during the screening process had prognostically favorable tumor characteristics compared to breast cancers without experiencing screening.2)When used alone,the MAM has the highest sensitivity,but false-positive rate is also higher,CBE,and BUS can be used as effective complement to MAM check,the three methods used in conjunction with the largest effect.3)The cost-effectiveness analysis showed that the CBE and BUS biennial breast cancer screening for women 35-69 years old age group in line with the principle of cost-effectiveness and producted the more QALY.4)In this study,the screening results for the first time screening,still need to continue the regularity of screening and long follow-up to confirm. |
PDF Full Text Request