上海市女性乳腺癌危险因素分析与风险预测模型研究

发布时间：2018-06-03 05:04

本文选题：乳腺癌 + 危险因素　；参考：《中华肿瘤防治杂志》2017年12期

【摘要】：目的乳腺癌风险预测模型可将人群分为不同的风险等级,有助于降低筛查成本,使乳腺癌筛查效益最大化。本研究分析了上海市女性乳腺癌的危险因素,初步建立了符合该人群流行病学特征的风险预测模型,为乳腺癌高危人群的筛选提供依据。方法 2008-05-23-2012-09-30,采用调查表对上海市闵行区149 577名35~74岁女性开展乳腺癌初筛,内容包括人口学、月经生育史、乳腺疾病史和家族史等信息,具备任一明确定义危险因素者为初筛阳性。将所有对象的个人信息与上海市肿瘤登记系统和生命统计系统进行记录联动,收集2015-06-30前乳腺癌确诊和全死因死亡信息。采用Cox比例风险模型,建立乳腺癌风险预测模型,计算乳腺癌5年发病风险,并采用5折交叉验证法,分别计算期望病例数与观察病例数比值(ratio of the expected to the observed number,E/O)和受试者工作特征曲线下面积(areas under the receiver operating characteristic curve,AUC),评价模型的校准度和区分力。结果经过774 333人年(中位随访人年5.05年)随访,共发现新发乳腺癌病例973例,粗发病率(crude incidence rate,CIR)和年龄标化率(age-standardized incidence rate,ASR)分别为125.66/10万和112.55/10万,初筛阳性者的粗率和标化率分别为133.91/10万和121.83/10万,显著高于初筛阴性者的119.76/10万和106.91/10万。年龄、教育程度、乳腺癌家族史、患重度乳腺小叶增生、有乳房肿块、患乳腺导管内乳头状瘤与乳腺癌呈正向关联,哺乳和月经周期规律与乳腺癌呈负向关联。基于这些因素建立的风险预测模型估计该人群乳腺癌5年绝对发病风险高峰出现在55岁,在0.19%~1.10%之间变化。模型的E/O值为0.98(95%CI为0.92,1.04),AUC为0.596(95%CI为0.538,0.654)。进一步按年龄分层,发现55岁以下组和55岁及以上组的E/O值分别为0.96(0.88,1.03)和1.01(0.91,1.16),AUC分别为0.627(0.514,0.701)和0.567(0.518,0.630)。结论本研究建立的风险评估模型主要基于自我报告的乳腺症状及体征,总体校准度较好,而总体区分力不理想,但在55岁以下女性中有所提高,可用于社区人群尤其是55岁以下人群的乳腺癌风险分级。
[Abstract]:Objective Breast cancer risk prediction model can divide the population into different risk levels, which is helpful to reduce the screening cost and maximize the efficiency of breast cancer screening. This study analyzed the risk factors of female breast cancer in Shanghai, and established a risk prediction model according to the epidemiological characteristics of the population, which provided the basis for screening high risk population of breast cancer. Methods 149,577 women aged 35 to 74 years old in Minhang District of Shanghai were screened for breast cancer by questionnaire from May to September 2009.The information included demography, menstrual history, breast disease history and family history. All subjects' personal information was recorded with Shanghai Cancer Registration system and vital Statistics system to collect the diagnosis and death information of breast cancer before 2015-06-30. Cox proportional risk model was used to predict breast cancer risk. The 5 year risk of breast cancer was calculated, and the 5% cross validation method was used. The ratio of expected cases to observed cases and the area under the operating characteristic curve were calculated to evaluate the calibration degree and distinguishing power of the model. Results after a follow-up of 774,333 person-years (median 5.05 years), 973 new breast cancer cases were found. The crude incidence rate and age-standardized incidence rate were 125.66 / 100 and 112.55 / 100 million, respectively. The crude rate and standardized rate of positive primary screening were 133.91 / 100 and 121.83 / 100, respectively, which were significantly higher than those of negative screening of 1.19 76 / 100 million and 106.91% / 100 000 respectively. Age, education, family history of breast cancer, severe breast lobule hyperplasia, breast mass, breast intraductal papilloma were positively correlated with breast cancer, lactation and menstrual cycle were negatively correlated with breast cancer. The risk prediction model based on these factors estimated that the absolute risk of breast cancer in this population peaked at 55 years old and varied between 0.19% and 1.10%. The E / O value of the model was 0.92 ~ 1.04A ~ (UC) = 0.538A ~ (0.654) ~ (-1). Furthermore, according to the age, it was found that the E / O values of the group under 55 and the group aged 55 and over were 0.96 ~ 0.881.03) and 1.01U _ (0.91) ~ (1.16) A ~ (UC) were 0.627 ~ 0.514 ~ (0.701) and 0.567n ~ (0.5) ~ (18) ~ (0.630), respectively. Conclusion the risk assessment model established in this study is mainly based on self-reported breast symptoms and signs. The overall calibration degree is good, but the overall discrimination is not ideal, but it is improved in women under 55 years of age. Can be used for the community population, especially under 55 years of age for breast cancer risk classification.
【作者单位】：复旦大学公共卫生学院流行病学教研室公共安全教育部重点实验室;闵行区疾病预防控制中心卫生科;闵行区疾病预防控制中心慢性病防治科;
【基金】：美国中华医学基金会(China Medical Board,HPSS 09-991) 上海市第四轮公共卫生计划重点学科建设课题(15GWZK0801) 上海市自然科学基金青年项目(12ZR1448700)
【分类号】：R737.9

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