Importance Given recent advances in screening mammography and adjuvant therapy (treatment), quantifying their separate and combined effects on US breast cancer mortality reductions by molecular subtype could guide future decisions to reduce disease burden. Objective To evaluate the contributions associated with screening and treatment to breast cancer mortality reductions by molecular subtype based on estrogen-receptor (ER) and human epidermal growth factor receptor 2 (ERBB2, formerly HER2 or HER2/neu). Design, Setting, and Participants Six Cancer Intervention and Surveillance Network (CISNET) models simulated US breast cancer mortality from 2000 to 2012 using national data on plain-film and digital mammography patterns and performance, dissemination and efficacy of ER/ERBB2-specific treatment, and competing mortality. Multiple US birth cohorts were simulated. Exposures Screening mammography and treatment. Main Outcomes and Measures The models compared age-adjusted, overall, and ER/ERBB2-specific breast cancer mortality rates from 2000 to 2012 for women aged 30 to 79 years relative to the estimated mortality rate in the absence of screening and treatment (baseline rate); mortality reductions were apportioned to screening and treatment. Results In 2000, the estimated reduction in overall breast cancer mortality rate was 37% (model range, 27%-42%) relative to the estimated baseline rate in 2000 of 64 deaths (model range, 56-73) per 100 000 women: 44% (model range, 35%-60%) of this reduction was associated with screening and 56% (model range, 40%-65%) with treatment. In 2012, the estimated reduction in overall breast cancer mortality rate was 49% (model range, 39%-58%) relative to the estimated baseline rate in 2012 of 63 deaths (model range, 54-73) per 100 000 women: 37% (model range, 26%-51%) of this reduction was associated with screening and 63% (model range, 49%-74%) with treatment. Of the 63% associated with treatment, 31% (model range, 22%-37%) was associated with chemotherapy, 27% (model range, 18%-36%) with hormone therapy, and 4% (model range, 1%-6%) with trastuzumab. The estimated relative contributions associated with screening vs treatment varied by molecular subtype: for ER+/ERBB2−, 36% (model range, 24%-50%) vs 64% (model range, 50%-76%); for ER+/ERBB2+, 31% (model range, 23%-41%) vs 69% (model range, 59%-77%); for ER−/ERBB2+, 40% (model range, 34%-47%) vs 60% (model range, 53%-66%); and for ER−/ERBB2−, 48% (model range, 38%-57%) vs 52% (model range, 44%-62%). Conclusions and Relevance In this simulation modeling study that projected trends in breast cancer mortality rates among US women, decreases in overall breast cancer mortality from 2000 to 2012 were associated with advances in screening and in adjuvant therapy, although the associations varied by breast cancer molecular subtype.

中文翻译：

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2000-2012 年美国女性不同分子亚型的乳腺癌死亡率筛查和治疗的关联

重要性 鉴于筛查乳房 X 线照相术和辅助治疗（治疗）的最新进展，量化它们按分子亚型对美国乳腺癌死亡率降低的单独和联合影响可以指导未来减少疾病负担的决策。目的通过基于雌激素受体 (ER) 和人表皮生长因子受体 2（ERBB2，以前称为 HER2 或 HER2/neu）的分子亚型，评估筛查和治疗对降低乳腺癌死亡率的贡献。设计、设置和参与者 六个癌症干预和监测网络 (CISNET) 模型使用国家数据模拟了 2000 年至 2012 年的美国乳腺癌死亡率，这些数据是关于 ER/ERBB2 特异性治疗的平片和数字乳房 X 线照相模式和性能、传播和功效，和竞争死亡率。模拟了多个美国出生队列。暴露筛查乳房 X 线照相术和治疗。主要结果和措施 模型比较了 2000 年至 2012 年 30 至 79 岁女性的年龄调整、总体和 ER/ERBB2 特异性乳腺癌死亡率与未进行筛查和治疗的情况下的估计死亡率（基线率); 死亡率的降低被分配到筛查和治疗中。结果 2000 年，相对于 2000 年每 100 000 名妇女 64 例死亡（模型范围，56-73）的估计基线率，总体乳腺癌死亡率的估计降低了 37%（模型范围，27%-42%）：这种减少的 44%（模型范围，35%-60%）与筛查有关，56%（模型范围，40%-65%）与治疗有关。2012 年，估计整体乳腺癌死亡率降低了 49%（模型范围，39%-58%）相对于 2012 年每 100 000 名女性 63 例死亡（模型范围，54-73）的估计基线率：这种减少的 37%（模型范围，26%-51%）与筛查和63%（模型范围，49%-74%）接受治疗。在与治疗相关的 63% 中，31%（模型范围，22%-37%）与化疗相关，27%（模型范围，18%-36%）与激素治疗相关，4%（模型范围，1%） -6%) 与曲妥珠单抗。与筛选与治疗相关的估计相对贡献因分子亚型而异：对于 ER+/ERBB2-，36%（模型范围，24%-50%）与 64%（模型范围，50%-76%）；对于 ER+/ERBB2+，31%（模型范围，23%-41%）与 69%（模型范围，59%-77%）；对于 ER-/ERBB2+，40%（模型范围，34%-47%）与 60%（模型范围，53%-66%）；对于 ER-/ERBB2-，48%（模型范围，38%-57%）与 52%（模型范围，44%-62%）。