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目的了解社区健康女性乳房钼靶筛查效果及乳腺癌危险因素。方法 2008年6月—2009年6月在上海市闵行区七宝社区居委、村委开展35～74岁女性危险因素问卷调查、乳房临床触诊及钼靶筛查。结果筛查3740例,检出乳腺癌16例,检出率427.81/10万,早期13例,其中原位癌3例,早期率81.25%;钼靶筛查原位癌比例高于非筛查人群;左右乳分别有1.15%及1.52%人群不宜参加钼靶筛查,集中于40～59岁人群,左右乳完全正常的占63.17%,62.42%,35.68%及36.06%的左右乳分别存在良恶性病变,可能良性疾病左右乳均集中于50～59岁;钼靶筛查灵敏度为0.93,特异度为0.98,约登指数0.92,阳性似然比53.47,阴性似然比0.07,一致率0.98,阳性预测值0.18,阴性预测值0.99。临床触诊灵敏度为0.75,特异度为0.42,约登指数0.17,阳性似然比1.30,阴性似然比0.59,一致率0.43,阳性预测值0.01,阴性预测值0.99;35～74岁钼靶普及率为15.24%;哺乳时间超过6个月是乳腺癌发病的保护因素(OR=0.30,95%CI:0.10～0.89),而一侧乳房癌史导致对侧乳房癌发病相对危险度为9.21(95%CI:1.05～81.07)。结论 35～74岁健康女性适宜开展钼靶筛查,临床触诊筛查具有一定效果。应加强健康教育,推广钼靶筛查,提倡哺乳。
Objective To understand the mammography screening effect and risk factors of breast cancer in healthy women in community. Methods June 2008 -2009 June in Shanghai Qibao community neighborhood committees and village committees to carry out 35 to 74-year-old female risk factors questionnaire, clinical breast palpation and mammography screening. Results 3740 cases were detected, 16 cases were detected breast cancer, the detection rate was 427.81 / 100000, early 13 cases, of which 3 cases of carcinoma in situ, the early rate of 81.25%; molybdenum target screening in situ carcinoma was higher than non-screening Population; about 1.15% of left and right breasts and 1.52% of the population should not participate in the screening of molybdenum targets, focusing on 40 to 59-year-olds, left and right breasts completely normal accounted for 63.17%, 62.42%, 35.68% and 36.06% Malignant lesions, probably benign disease around the milk are concentrated in the 50 to 59 years old; screening sensitivity of molybdenum target 0.93, specificity of 0.98, Youden index of 0.92, positive likelihood ratio of 53.47, negative likelihood ratio of 0.07, the coincidence rate of 0.98, Positive predictive value of 0.18, negative predictive value of 0.99. The sensitivity of clinical palpation was 0.75, specificity was 0.42, Youden index was 0.17, positive likelihood ratio was 1.30, negative likelihood ratio was 0.59, concordance rate was 0.43, positive predictive value was 0.01 and negative predictive value was 0.99. (OR = 0.30, 95% CI: 0.10-0.89), while the incidence of breast cancer on one side led to a relative risk of contralateral breast cancer of 9.21 (OR = 0.30, 95% CI: 95% CI: 1.05 ~ 81.07). Conclusion The 35-74-year-old healthy women are suitable for mammography screening and clinical palpation screening. Health education should be strengthened to promote the screening of molybdenum targets to promote breastfeeding.