| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學系公共衛生學碩士班 === 106 === Background: From 2004, biennial nationwide mammography screening was utilized by women whose age 50 to 69 years old in Taiwan. Since 2010, the national cancer screening expanded access of care through both out-reach and in-reach services for providing mammography services to women who were eligible for the screening. Using ten years nationwide breast cancer screening registry, the purpose of this study was to compare the prognosis and up-to-date screening among those women who utilized mammography screening before (phase of 2005-2009) and after (phase of 2010-2014) the implementation of the policy with expansion of mammography screening accessibility.
Method: The retrospective population-based cohort study was conducted by using 4 databases in Taiwan. After using propensity score matching with 1 to 1 matching which adjusted covariates including age categories, residence, education level, income level, BMI, family history, menarche age, menopause, fertility times and Charlson Comorbidity Index, women utilizing first-time mammography screening with age 50-69 years in 2 phases of 2005-2009 and 2010-2014 were compared. We evaluated the difference of up-to-date screening and advanced stage of breast cancer diagnosis in 2 phases by multivariate logistic regression. Then the difference of all-cause mortality, overall cancer mortality, and breast cancer mortality in 2 phases were analyzed by Cox proportional hazard model.
Result: Our finding indicated that the phase of 2010-2014 had more chance of up-to-date screening than the phase of 2005-2009 (OR:2.76, 95% CI: 2.73-2.78, p-value < 0.001). There was nearly the same rate of early stage diagnosis of breast cancer among 2 phases; no significant difference was in the risk of advanced stage of breast cancer diagnosis between 2 phases (OR:0.92, 95% CI: 0.80-1.07, p-value: 0.281). Mortality of all-cause death and overall cancer death were higher in the phase of 2010-2014 than in 2005-2009. However, the hazard ratio of breast cancer mortality was not significantly different between 2 phases (HR:1.23, 95% CI: 0.93-1.63, p-value: 0.140).
Conclusion: More eligible women utilized mammography screening after the policy about expansion of access of screening service, whereas the rate of up-to-date screening was higher in the phase of 2010-2014 than in the phase of 2005-2009. Besides, there was nearly the same rate of early stage of breast cancer diagnosis in 2 phases. Although no significant difference in the risk of breast cancer mortality between 2 phases was observed, further study could evaluate the prognosis between women with screening and those without screening.
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