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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2020; 17(02): 105-112
DOI: 10.1055/a-1157-5015
Wissenschaftliche Arbeit

Stratifizierung des Brustkrebsrisikos hinsichtlich der Einflüsse von Alter und mammografischer Dichte

Stratification of Breast Cancer Risk in Terms of the Influence of Age and Mammographic density
Stefanie Weigel
1   Institute of Clinical Radiology and Reference Center for Mammography Münster, University and University Hospital Münster, Germany
,
Walter Heindel
1   Institute of Clinical Radiology and Reference Center for Mammography Münster, University and University Hospital Münster, Germany
,
Caroline Dietz
2   Screening Unit, Leverkusen, Germany
,
Ulrike Meyer-Johann
3   Screening Unit, Bielefeld, Germany
,
Axel Graewingholt
4   Screening Unit, Paderborn, Germany
,
Hans Werner Hense
5   Institute of Epidemiology and Social Medicine, University of Münster, Germany
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Zusammenfassung

Ziel Analyse des Einflusses der singulären Risikofaktoren Lebensalter und Brustdichte auf die 2-Jahres-Inzidenz des Mammakarzinoms unter Teilnehmerinnen am deutschen Mammografie-Screening-Programm.

Material und Methode Die multizentrische Studie umfasst 111 456 digitale mammografische Folgerunden-Untersuchungen aus 4 Screening-Einheiten mit prospektiver visueller Kategorisierung der Brustdichte. Basierend auf der Detektion im Screening und im 2-Jahres-Intervall nach negativer Screening-Teilnahme (Intervallkarzinome) wurden 2-Jahres-Brustkrebsinzidenzen (2-JBI) (‰) in den 5-Jahres-Altersgruppen (5-JAG) der Zielgruppe 50–69 Jahre und in den Dichtekategorien ACR 1–4 berechnet. Multivariate statistische Auswertungen erfolgten mit logistischen Regressionsmodellen.

Ergebnisse Mit steigender 5-JAG stieg die 2-JBI von 5,0 ‰, 6,7 ‰ und 8,5 ‰ auf 9,7 ‰ und unterschied sich unter den 55–59-, 60–64- und 65–69-jährigen Frauen signifikant von der jüngsten Referenzgruppe 50–54 Jahre (Odds-Ratio (OR): 1,34, 1,68 bzw. 1,93; p < 0,0001). Mit Anstieg der ACR-Kategorien 1–4 nahm die 2 JBI von 2,6 ‰, auf 5,8 ‰, 9,6 ‰ und 9,7 ‰ zu. Die 2-JBI unterschied sich in ACR 2, 3 und 4 signifikant von der Referenzgruppe ACR 1 (OR: 2,17, 3,65 bzw. 3,76; p < 0,0001). Nur innerhalb der beiden Hauptgruppen ACR 2 (Häufigkeit 44,3 %) und ACR 3 (44,7 %) zeigte sich ein signifikanter Anstieg der 2-JBI über die 5-JAG (ACR 2: 3,7 ‰–8,9 ‰; ACR 3: 5,8 ‰–11,7 ‰; p < 0,001). 2-JBI lagen über dem Median von 7,5 ‰ bei Frauen mit ACR 2 und Alter 65–69 Jahre sowie bei ACR 3 und ACR 4 im Alter 55–69 Jahre. 2-JBI unter dem Median hatten Frauen zwischen 50–54 Jahren, unabhängig von der Brustdichte, sowie Frauen der Kategorie ACR 1 in allen Altersgruppen.

Schlussfolgerung Innerhalb der Hauptkategorien ACR 2 und ACR 3 (fast 90 % der Teilnehmerinnen) steigen die Inzidenzen mit zunehmendem Alter bis zu einer Verdopplung. Eine konsistent niedrige Inzidenz findet sich unabhängig von der Brustdichte bei jungem Screening-Alter und bei Frauen mit geringster Brustdichte.

Abstract

Purpose Analysis of the influence of the singular risk factors age and breast density on the 2-year incidence of breast cancer among participants in the German mammography screening program.

Materials and Methods The multicenter study includes 111 456 subsequent round digital mammographic screening examinations from four screening units with prospective visual categorization of breast density. Based on detection in screening and during the 2-year interval after negative screening participation (interval cancers), 2-year breast cancer incidences (2 YBCI) (‰) were calculated in the 5-year age groups (5 YAG) of the target group 50–69 years and in the BI-RADS density categories ACR 1–4. Multivariate statistical evaluations were carried out using logistic regression models.

Results With an increase in the 5 YAG, the 2 YBCI increased by 5.0 ‰, 6.7 ‰, 8.5 ‰ to 9.7 ‰, and was significantly different among 55–59, 60–64 and 65–69-year-old women compared to the youngest reference group 50–54 years (odds ratio (OR): 1.34; 1.68; and 1.93; p-value < 0.0001). With an increase in density categories 1–4, the 2 YBCI increased from 2.6 ‰, to 5.8 ‰, 9.6 ‰, and 9.7 ‰. The 2 YBCI differed significantly in breast density categories 2, 3, 4 from reference group 1 (OR: 2.17; 3.65; and 3.76; p-value < 0.0001). Only within the two main breast density groups 2 (frequency 44.3 %) and 3 (44.7 %), a significant increase in the 2 YBCI was observed across the 5 YAG (category 2: 3.7–8.9 ‰; category 3: 5.8–11.7 ‰; p-value < 0.001 each). The 2 YBCI was above the median of 7.5 ‰ in women with breast density category 2 and aged 65–69 years, as well as in women with breast density categories 3 and 4 aged 55–69 years. A 2 YBCI below the median was seen in women between 50–54 years regardless of breast density, as well as women in category 1 in all age groups.

Conclusion Within the main breast density categories 2 and 3 (almost 90 % of participants), incidences increase with age to double. A consistently low incidence is found regardless of breast density at a young screening age and in women with the lowest breast density.

Key words

breast cancer screening - digital mammography - breast density - age - interval cancer - population surveillance


Publication History

Article published online:
25 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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