| Part one: Prevalence and screening of female breast cancer in Hebei ProvinceObjective: The results of female breast cancer screening in the urban cancer early diagnosis and treatment project in Hebei Province(the female breast cancer screening project in Hebei Province)were collected and analyzed.Methods: This study included people who participated in the project of early diagnosis and treatment of urban cancer in Hebei Province from November 2016 to April 2020.The risk assessment of the participants was assessed through epidemiological questionnaire survey,and the high-risk group of breast cancer was screened out,and the clinical screening including breast ultrasound and(or)mammography(molybdenum target)examination was carried out.Chi square test and logistic regression were used to analyze the clinical characteristics of breast cancer positive patients.Results:1.From November 2016 to April 2020,a total of 84029 women participated in the questionnaire survey of urban cancer early diagnosis and treatment project in Hebei Province,from which 20655 high-risk populations of breast cancer were evaluated,with a high-risk rate of 24.58%.There were13392 high-risk groups who completed the breast cancer screening program,and the screening participation rate was 64.84%.There were 12805,10894 and 10307 people participated in ultrasound screening,mammography screening and combined screening,respectively and the participation rates were 61.99%,52.74% and 49.90%,respectively.2.The results show that among the 12805 breast cancer high-risk patients who participated in the ultrasound screening program,there were 3104 breast cancer patients,accounting for 24.24% of all ultrasound screening participants.Among 10894 high-risk breast cancer patients who participated in mammography screening,644 patients were detected with mass and 3594 patients with calcification,accounting for 5.91% and 32.99% of all mammography screening patients,respectively.A total of 8851(81.25%)breast parenchyma types were reported by mammography screening.There were 586(6.62%),2482(28.04%),5565(62.87%)and 218(2.47%)breast parenchyma types were fat type,scattered fibrous gland type,uneven dense type and extremely dense type,respectively.3.A total of 2585 suspected positive cases(BI-RADS 3)were detected in13392 high-risk groups who completed the breast cancer screening program,with a suspicious positive detection rate of 19.30%.A total of 513 positive cases(BI-RADS 4 and BI-RADS 5)were detected,with a positive detection rate of 3.83%.The suspicious positive rates of ultrasound,mammography and combined screening were 15.00%,9.20% and 21.01% respectively,and the positive rates were 2.11%,2.76% and 4.36% respectively.4.The basic characteristics of breast cancer screening positive people in Hebei Province were analyzed.The results showed that there were significant differences in type of breast parenchyma,education level,marital status and occupation(P < 0.05).The OR values were 1.296,1.325,2.108 and 0.585,respectively.There was no significant difference in nationality and BMI(P >0.05).Conclusions: The participation rate of breast cancer screening in Hebei Province was 64.84%,and the overall participation rate of breast cancer screening project was good.We should continue to improve the publicity and popularization of breast cancer screening project.Participating in breast cancer screening program can find breast cancer positive lesions,breast space occupying lesions,breast masses and breast calcification.Compared with ultrasound or mammography alone,the current combined screening program has a higher positive detection rate.Part two: Health economic evaluation of female breast cancer screening based on Markov modelObjective: The health economics evaluation of female breast cancer screening model in Hebei Province was carried out by constructing decision analysis Markov model.To select the more advantageous screening program,and provide reference for optimizing the formulation of breast cancer screening plan in Hebei Province.Methods: The decision analysis Markov model was constructed by Tree Age Pro(2011 Edition).Based on the Markov model,the initial population distribution was determined through the female breast cancer screening project in Hebei Province.The relevant parameters needed to construct the model were obtained by referring to the annual report of cancer registration in Hebei Province in 2019,China Health Statistics Yearbook and the relevant literature research results.In order to estimate the cost-effectiveness and health economics of different screening programs,we simulated the expected health outcomes of 100000 women with the initial age of 40 years under female breast cancer screening in the urban cancer early diagnosis and treatment project in Hebei Province in different screening cycles(once a year,once two years and once three years)and different screening programs(ultrasound only,molybdenum target only and combined ultrasound and molybdenum target screening)in the next 45 years.Results:1.To simulate the expected health outcomes of 100 000 female breast cancer screening population in Hebei Province with the initial age of 40 years under the ultrasound,mammography and combined screening programs every1 year,every 2 years and every 3 years in the next 45 years.The results showed that the screening effect of the combined screening program once a year was the best,and the improvement of the effect was the most obvious in each screening group.At the end of the 45 th cycle,the early diagnosis rate of combined screening program once a year was 65.49%,and the proportion of stage IV breast cancer decreased to 18.15%.In the next 45 years,compared with the non screening group,the early diagnosis rate of the combined screening program once a year increased by 68.00%,the incidence rate of stage IV breast cancer decreased by 24.00%,and the mortality of breast cancer decreased by 24.24%.2.Through economic analysis and comparison,the results show that when the willingness to pay threshold was 213000 yuan and the life years(Lys)is taken as the effect index,the cost-effective programs are three screening frequencies of ultrasound screening programs(once a year,once every two years and once every three years)and mammography screening once every 2years.Each additional unit of LY costs 97933,98833,94484 and 203480 yuan,respectively.Among them,the most cost-effective advantage is the three-year ultrasound screening program,followed by the one-year ultrasound screening program.After adjusting the quality of life,when the quality adjusted life years(QALYs)were used as the effect index,the cost-effective programs were three kinds of screening frequency: once a year,once every two years and once every three years.Each additional unit of QALY costs 116876,118090 and 113037 yuan respectively.Once every three years is still the most cost-effective program.Conclusions: Among the nine screening schemes studied in this paper,once a year ultrasound screening scheme has cost-effective advantages and better effect.If economic conditions permit,it is recommended to adopting.The unit incremental cost of the three-year ultrasound screening program is the lowest,which is the most economical screening program.The effect of once a year combined screening program is the best,but the cost-effectiveness is low. |
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