PO.PS01.09 · 人群科学
乳腺癌筛查三十年与社会经济不平等：一项基于芬兰全国登记数据的研究
Thirty years of breast cancer screening and socioeconomic inequalities: A national register-based study in Finland
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摘要 Abstract
中文摘要
背景：芬兰全国性乳腺癌筛查项目自1992年起运行，然而筛查的长期效果及社会经济不平等仍未得到充分阐明。本研究考察了30年的筛查邀请、参与率、诊断分期与死亡率，重点关注教育程度差异。
方法：我们使用了大规模筛查登记处（Mass Screening Registry）的数据，其中包含1992—2022年间向120万名50—69岁女性发出的超过800万份筛查邀请。这些数据与芬兰统计局（Statistics Finland）的人口统计信息以及芬兰癌症登记处（Finnish Cancer Registry）的癌症诊断记录进行了关联。所有受邀者及其参与情况均按教育程度分层。采用Kaplan-Meier生存曲线评估不同教育程度和筛查参与状态间的生存差异。总体死亡率采用Cox比例风险模型分析，并对教育程度、婚姻状况、居住地城市化水平及诊断分期进行了校正。采用logistic回归模型评估筛查和教育程度对早期检出（I—II期 vs. III—IV期）的影响。
结果：筛查参与率呈现明显的社会经济梯度（低教育程度80.2%，中等84.7%，高85.7%），并随年份略有下降。总体而言，接受筛查女性的平均死亡年龄高于未筛查女性（+2.65岁，81.73 vs. 79.08），且该生存优势在低教育程度组中最大（+3.51岁，81.12 vs. 77.61），高于高教育程度组（+1.56岁，82.38 vs. 80.82）。经充分校正后，筛查参与与死亡率降低54%相关（HR = 0.46，95% CI 0.45—0.46）。接受筛查的女性早期诊断的几率是未筛查者的两倍以上（OR = 2.31，95% CI 2.00—2.68）。高教育程度女性比低教育程度女性更可能获得早期诊断（OR = 1.80，95% CI 1.52—2.13）。
结论：参与全国乳腺癌筛查项目与生存改善、显著更早的检出以及大幅降低的死亡风险密切相关。尽管低教育程度女性在参加筛查时获得的绝对生存获益最大，但其较低的参与率导致了持续存在的社会经济不平等。有针对性地提高弱势群体的筛查参与率或可缩小这些差距。
主要信息：总体而言，全国乳腺癌筛查项目在改善生存和促进早期检出方面表现出强有力的有效性，同时凸显了需要有针对性关注的持续存在的社会经济不平等。
查看英文原文 English abstract
Background : The national wide Finnish breast cancer screening program has operated since 1992, yet the long-term effects of screening and socioeconomic inequalities remain incompletely characterized. This study examines 30 years of screening invitations, participation, diagnostic stage, and mortality, with a focus on educational disparities.
Methods: We used data from the Mass Screening Registry, which contains more than 8 million screening invitations issued to 1.2 million women aged 50-69 during 1992-2022. These data were linked with demographic information from Statistics Finland and cancer diagnosis records from the Finnish Cancer Registry. All invited individuals and participation were stratified by education. Survival differences by educational level and screening participation status were assessed using Kaplan-Meier survival curves. Overall mortality was analyzed using Cox proportional hazards models adjusted for education, marital status, urbanization level of residence, and stage at diagnosis. Effects of screening and education on early-stage detection (stage I-II vs. III-IV) were assessed using logistic regression models.
Results: Screening participation displayed a clear socioeconomic gradient (low education 80.2%, medium 84.7%, high 85.7%) and slightly decreased by year. Mean age at death was higher among screened than
unscreened women overall (+2.65 years, 81.73 vs. 79.08), and the survival advantage was largest in the lower-educated group (+3.51 years, 81.12 vs. 77.61) than in the higher-educated group (+1.56 years, 82.38 vs. 80.82). Screening participation was associated with a 54% reduction in mortality (HR = 0.46, 95% CI 0.45-0.46) after full adjustment. Screened women had more than double the odds of early-stage diagnosis (OR = 2.31, 95% CI 2.00-2.68). Higher-educated women were more likely to receive an early-stage diagnosis (OR = 1.80, 95% CI 1.52-2.13) than lower-educated women.
Conclusions: Participation in the national breast cancer screening program is strongly associated with improved survival, markedly earlier detection, and substantially reduced mortality risk. Although women with lower education gain the largest absolute survival benefit when they attend screening, their lower participation rates contribute to persistent socioeconomic inequalities. Targeted efforts to increase screening uptake among disadvantaged groups may reduce these disparities.
Main messages: Overall, the national breast cancer screening program demonstrates strong effectiveness in improving survival and promoting earlier detection, while highlighting persistent socioeconomic inequalities that require targeted attention.
利益披露 Disclosure
P. Li, None..
P. Martikainen, None..
M. Myrskylä, None.