近日，瑞典卡罗林斯卡医学院Wei He团队研究了第一次乳房x光检查参与和随后25年的乳腺癌发病率和死亡率：基于人群的队列研究。2025年9月24日，《英国医学杂志》发表了这一成果。

为了确定未参加第一次乳房x光检查邀请的妇女是否有不良的筛查依从性和乳腺癌结局的长期风险，研究组在瑞典斯德哥尔摩进行了一项基于人群的队列研究。

参与者为432775名在1991年至2020年间接受瑞典乳房x线摄影筛查项目邀请的女性，她们最初被邀请的年龄为50岁或40岁。主要测量筛查依从性、乳腺癌发病率、肿瘤特征和乳腺癌死亡率，通过与多个瑞典国家登记册的联系进行追踪，随访至2023年（长达25年的随访期）。从第一次参加筛查开始计算累积乳腺癌发病率。Cox比例风险模型估计乳腺癌死亡率的风险比；Logistic回归模型通过优势比评估与肿瘤特征的关联。

在总共4940375人年的随访中，16059例新发乳腺癌病例被记录在案。在首次接受乳房x光检查的女性中，32.1% (n=138760)没有参加。一直不太可能参加后续的筛查，更有可能发现症状，诊断为晚期乳腺癌。具体来说，与第一次筛查相比参与者与非参与者III期癌症（160例（4.1%）vs 266例（2.9%））的比值比为1.53(95%可信区间为1.24 ~ 1.88)，IV期癌症（150例（3.9%）vs 105例（1.2%））的比值比为3.61（2.79 ~ 4.68）。在总共6818686人年的随访中，有1603人死于乳腺癌。未参加首次筛查也与乳腺癌死亡率显著升高相关，25年累计死亡率为9.9 / 1000，而参与者为7.0% / 1000（调整后的风险比1.40，95%置信区间1.26 ~ 1.55）。相比之下，25年的乳腺癌发病率在两组之间是相似的，参与者为7.8%，而非参与者为7.6%，表明第一次筛查时的死亡率升高可能反映了发现延迟而不是发病率增加。

这项研究表明，首次筛查的非参与者代表了大量长期有死于乳腺癌风险的人群，这为有针对性的干预提供了机会，以提高筛查的依从性，从而降低死亡风险。

附：英文原文

Title: First mammography screening participation and breast cancer incidence and mortality in the subsequent 25 years: population based cohort study

Author: Ziyan Ma, Wei He, Yuqi Zhang, Xinhe Mao, José Tapia, Per Hall, Keith Humphreys, Kamila Czene

Issue&Volume: 2025/09/24

Abstract:

Objective To determine whether women who did not attend their first mammography screening invitation have a long term risk of poor screening adherence and breast cancer outcomes.

Design Population based cohort study.

Setting Stockholm, Sweden.

Participants 432775 women who received invitations to the Swedish Mammography Screening Programme between 1991 and 2020 and were initially invited at either 50 years of age or 40 years of age.

Main outcome measures Screening adherence, breast cancer incidence, tumour characteristics, and breast cancer mortality tracked through linkage to multiple Swedish national registers, with follow-up until 2023 (up to 25 year follow-up period). Cumulative breast cancer incidences were calculated from first screening participation. Cox proportional hazards models estimated hazard ratios for breast cancer mortality; logistic regression models assessed associations with tumour characteristics by odds ratios.

Results During a total of 4 940 375 person years of follow-up, 16059 new cases of breast cancer were documented. Among women invited to their first mammography screening, 32.1% (n=138760) did not participate. These non-participants were persistently less likely to attend subsequent screenings and were more likely have symptom detected, advanced stage breast cancer diagnosed. Specifically, compared with first screening participants, non-participants had an odds ratio of 1.53 (95% confidence interval 1.24 to 1.88) for stage III cancer (160 (4.1%) v 266 (2.9%) cases) and 3.61 (2.79 to 4.68) for stage IV cancer (150 (3.9%) v 105 (1.2%) cases). During a total of 6 818 686 person years of follow-up, 1603 deaths from breast cancer were documented. Non-participation at first screening was also associated with significantly higher breast cancer mortality, with a 25 year cumulative mortality of 9.9 per 1000 versus 7.0 per 1000 for participants (adjusted hazard ratio 1.40, 95% confidence interval 1.26 to 1.55). By contrast, the 25 year breast cancer incidence was similar between groups (7.8% in participants versus 7.6% in non-participants), suggesting that the elevated mortality among first screening non-participants likely reflects delayed detection rather than increased incidence.

Conclusions This study shows that first screening non-participants represent a large population at long term risk of dying from breast cancer, providing an opportunity for targeted interventions to improve adherence to screening and thereby decrease mortality risk.

DOI: 10.1136/bmj-2025-085029

Source: https://www.bmj.com/content/390/bmj-2025-085029