[[alternative]]Analysis of Breast Cancer Screen and the Treatment by Using National Health Insurance Database

[[abstract]]背景：乳癌自2003年起即成為我國女性癌症發生原因第一位，死亡原因之第四位，而經過乳癌篩檢早期發現早期治療，可提高乳癌存活率，但我國以全人口為基礎之全民健康保險資料庫探討乳癌篩檢及治療情形之研究非常有限。目的：1.分析2008年乳癌新發病患，於過去2005年至2007年間執行乳癌篩檢之情形；2.比較不同乳癌篩檢類型乳癌病患確診日期，距離過去最後執行乳癌篩檢日期之時間；3.比較不同乳癌篩檢類型乳癌病患之治療型態。方法：本研究使用國家衛生研究院發行全民健康保險資料庫2003年至2010年之門診處方及治療明細檔(CD)、住院醫療費用清單明細檔(DD)、門診處方醫令明細檔(OO)、住院醫療費用醫令清單明細檔(DO)及2008年之承保資料檔(ID)，利用SAS 9.3統計套裝軟體進行資料分析，以描述性統計描述台灣2008年乳癌新發病患，於過去2005年至2007年間乳癌篩檢（包含乳房攝影及乳房超音波）利用情形，比較不同乳癌篩檢類型乳癌病患之確診日期，距離過去最後執行乳癌篩檢日期之月數，並比較不同乳癌篩檢類型乳癌病患2008年至2010年間之治療型態。結果：7,569位研究對象（2008年乳癌新發病患）於2005至2007年乳癌篩檢利用情形，無接受乳癌篩檢之人數較多，共5,734位佔研究對象75.76%；有接受篩檢之人數較少，共1,835位佔研究對象24.24%，其中以乳房攝影及乳房超音波兩種篩檢皆接受者為最多(11.18%)。研究對象確診乳癌前，最後一次乳癌篩檢為乳房攝影者共468位，篩檢後12個月內確診乳癌之人數為124位(26.5%)，13至23個月內確診乳癌之人數為133位(28.42%)，以篩檢後24個月以上確診之人數為最多，有211位(45.09%)；最後一次乳癌篩檢為乳房超音波者共521位，篩檢後12個月內確診乳癌之人數為193位(37.04%)，13至23個月內確診乳癌之人數為164位(31.48%)，篩檢後24個月以上確診之人數亦為164位(31.48%)；而2005至2007年有接受乳房攝影及乳房超音波兩種篩檢之人數共846位，篩檢後12個月內確診之人數為444位(52.48%)，篩檢後13至23個月確診之人數為256位(30.26%)，24個月後才確診之人數共146位(17.26%)。以不同乳癌篩檢之利用情形，比較研究對象後續使用之治療型態，結果顯示無做乳癌篩檢及有做乳癌篩檢後續使用之治療，佔比例最高的皆為合併使用手術、放射線治療、化學治療及荷爾蒙治療，未接受乳癌篩檢之研究對象使用此治療組合之比例有29.02%，高於曾執行乳房攝影者27.99%、乳房超音波者26.87%及兩種篩檢皆執行者25.89%。治療組合合併使用手術、放射線治療及化學治療，佔研究對象未做乳癌篩檢者後續使用之治療13.03%，曾接受乳房攝影者11.54%、乳房超音波者9.40%、兩種篩檢皆接受者12.29%。未做過乳癌篩檢之研究對象後續單純使用荷爾蒙治療之比例為0.30%；曾接受過乳房攝影者為0%、乳房超音波為0.19%、兩種乳癌篩檢皆接受者則佔0.12%。未做過乳癌篩檢之研究對象後續使用化學治療之比例為0.65%；曾接受過乳房攝影之研究對象則為0.21%、乳房超音波0%、兩種乳癌篩檢皆接受者0.24%。結論：本研究發現過去未接受乳癌篩檢之乳癌病患，後續使用之治療型態大多屬提供較晚期乳癌患者所使用之治療；反之，過去曾接受乳癌篩檢之乳癌病患，後續所使用之治療，大多屬乳癌分期較早期之病患使用，故以此推論乳癌篩檢有助乳癌患者及早發現及早治療。建議衛生主管機關應更加積極宣導乳癌篩檢之益處，多與社區結合，主動接近未自我發現病灶之女性，並針對影響女性接受乳癌篩檢之負向因素進行排除。[[abstract]]Background: Since 2003, breast cancer became the first cause of female cancer, the fourth leading cause of death, and after an early screening of breast cancer detection and early treatment can improve the survival rate of breast cancer. But in Taiwan, to the whole of the population-based National Health Insurance Database investigate the case study of breast cancer screening and treatment are very limited.Objectives: First, analysis of years 2008 patients with new-onset breast cancer, breast cancer screening of the implementation situation in the past between years 2005-2007. Second, compare patients of breast cancer with different types of breast cancer screening, date from which the last date of the breast cancer screening and the last diagnosed time. Third, to compare different types of breast cancer screening of the breast cancer treatment patterns.Methods: This study used the longitudinal National Health Insurance Database from years 2003-2010 outpatient prescriptions and treatment details files(CD), inpatient medical expense detail list file(DD), medical outpatient prescription order detail file(OO), a list of the medical hospitalization expenses detailed file(DO) and years 2008 data of ID file. SAS 9.3 program was used for data analysis. Initially, descriptive statistical analysis was performed for the regions in Taiwan between the years 2008 patients with new-onset breast cancer, breast cancer screening situation (mammography and breast echogram) in the past from 2005-2007. Compare difference in time from different types of breast cancer screening date to the diagnosis of breast cancer. And compare the treatment patterns from 2008-2010 between the different types of breast cancer screening.Results:The breast cancer screening use case between 7,569 study (2008 patients with new-onset breast cancer) in 2005-2007, the number of breast cancer screening without receiving is more, accounting for 75.76 percent in the study; there the number of breast cancer screening receiving is less, accounting for 24.24 percent in the study, of which two kinds of mammography and breast ultrasound screening recipients are most (11.18%), followed by breast ultrasound (6.88%), had received the lowest number of screening mammography (6.18%) . Diagnosed with breast cancer before the study, and the last of mammography screening for breast cancer, their screening from the diagnosis of the time difference of greater than 24 months is the most, there are 211 (45.09%); the last time breast cancer screening by breast ultrasound of the time difference from the diagnosis to more than 24 months and 13-23 months is the most, are all 164 (31.48%); the last type of breast cancer screening for the mammography and breast ultrasound both are accepted , its screening from the diagnosis of the time difference to 13-23 months is the most, there are 256 (30.26%), followed by less than six months, 233 (27.54%). Study in 2008-2010 had never received any treatment has 18, accounting subjects for 0.24%. To compare the treatment patterns for subsequent use in different breast cancer screening, the results show no matter what breast cancer screening do or do not, the highest proportion are all used in combination surgery, radiation therapy, chemotherapy and hormone therapy, did not receive breast cancer screening study used in a proportion of this portfolio had 29.02 percent, higher than had been mammography were 27.99%, breast ultrasound screening were 26.87% and the two actors were 25.89% . The therapy use of combination is surgery, radiation therapy and chemotherapy, making the accounting treatment of without breast cancer screening study by the subsequent use of 13.03 percent, had received 11.54 percent by mammography, breast ultrasound were 9.40%, two screening are accepted by 12.29%. Did not follow-up study of breast cancer screening alone hormone therapy used in a proportion of 0.30%; had received mammograms were 0%, 0.19% breast ultrasound, breast cancer screening are two recipients accounted for 0.12%. The proportion of breast cancer screening have not done the research object of subsequent use of chemical treatment of 0.65%; had received a mammogram of the study, compared with 0.21% 0% breast ultrasound, breast cancer screening are the two recipients of 0.24%.Conclusions: The study showed that breast cancer patients did not receive breast cancer screening in the past, the subsequent use of the treatment patterns to provide are mostly used in the late stage; on the contrary, breast cancer patients in the past had received breast cancer screening, the use of subsequent therapy are most belong to the earlier stages, so this inference breast cancer screening can help women with breast cancer early detection and early treatment. We suggest that health authorities should be more active advocacy of the benefits of breast cancer screening pilot, multi-combined with the community, approached more female with no lesions of self-discovery, and exclude the influence of women receiving breast cancer screening of negative factors