探討乳癌病人篩檢與診斷期別、存活率及醫療利用間之相關性

The study on the relationship between breast cancer screening and staging on diagnosis, survival medical utilization

鄭資津(Tzu-Chin Cheng)

指導教授 ： 羅英瑛 ； 張肇松

義守大學/管理學院/管理碩博士班/碩士(2016年)

摘要

目標:研究目的主要為了解乳癌病人，篩檢對其診斷時癌症分期、醫療利用與醫療費用之相關性及存活率。
方法:本研究採回溯研究法，進行次級資料分析，運用某區域教學醫院之 2011 年 1 月 1日至2013 年12 月31 日，癌症登記及病歷基本檔資料，並經由國民健康署大乳口系統確認為罹癌前有無進行乳房攝影癌症篩檢，研究期間共471 位乳癌個案，排除44位資料不全，有效樣本為427位。本研究工具採用IBM SPSS 18 Statistics進行分析，運用描述性統計、卡方檢定/T檢定(單因子變異數分析)、羅吉斯迴歸、線性迴歸及K-M 存活率等進行分析。
結果:其中乳癌確診前曾接受乳癌篩檢者有213位，佔49.88%，沒有者214位，佔50.12%。研究結果發現本研究樣本之人口變項與乳癌篩檢有相關，經分析結果顯示診斷年齡50~65歲執行篩檢為50歲0.22倍，教育程度高執行篩檢比率少教育程度低0.2
倍。有乳癌篩檢較易發現原位癌或第一期別癌症，有執行癌症篩檢者其存活率較無篩檢者久，有篩檢者平均住院天數約10.1天，較無篩檢者13.4 天短。另個案有共病對篩檢因素及醫療利用皆有顯著貢獻程度。
結論: 有乳癌篩檢者易發現分期原位癌及第一期之期別癌症其存活率較長，建議符合國健署推廣之乳癌篩檢年齡，應進行乳房篩檢。經本研究樣本統計顯示，教育程度高者較不易進行乳癌篩檢與目前臨床業務推廣現象趨勢相同，未來研究建議可以針對教育程度高(為高中職學歷以上)這族群進行乳癌篩檢推廣及行銷。

關鍵字

乳癌篩檢 ； 診斷分期 ； 存活率 ； 醫療利用 ； 醫療費用

並列摘要

Objective : The main purpose of research is to understand breast cancer patients, their diagnosis when screening for cancer staging, use of medical care and medical expenses of the relevance and viability.
Methods: This retrospective study mining research, conducted a secondary data analysis, the use of a regional teaching hospital of January 1, 2011 to December 31 2013, Cancer Registry and medical records basic information, and Bureau of Health Promotion, Department of
Health, R.O.C system is recognized as presence or absence of developing cancer. Before the cancer mammography screening for breast cancer during the study period a total of 471 cases, excluding 44 incomplete, effective sample of 427. The research tool uses IBM SPSS 18
Statistics were analyzed using descriptive statistics, chi-square test / T test (one-way analysis of variance), logistic regression, linear regression and K-M survival were analyzed. Result: The diagnosis of breast cancer in which the breast cancer screening ago to accept
those who have 213, accounting for 49.88%, not those 214, accounting for 50.12%. Theresults of this study found that the population sample of variables related with breast cancer screening. The analysis showed that 50 to 65 years age at diagnosis was 50 years old to
perform screening0.22 times. Performing a low level of education high screening rates at least 0.2 times the level of education. There are easier to find in situ breast cancer screening or the first part of another cancer, cancer screening by the Executive survival rate than those
without screening were long. There is screening an average hospital stay of about 10.1 days,compared with no screening were 13.4 short days. There are other cases of comorbidity factors and screening for medical use significant contribution level.
Conclusion: Early diagnosis of the study show a better prognosis, lower medical utilization and fewer medical costs, and also the promotion of health policy, provided by the national health insurance spending for breast cancer prevention and health care of the screening, Hope
all the people involved. Finally, we expect to take an evidence in favor of the business of promoting breast cancer screening.

並列關鍵字

Breast cancer ； screening ； staging ； survival ； medical utilization

參考文獻

徐珮絜、徐佩玉、吳瑋玲、江純櫻、徐南麗. (2015). 影響護理人員對乳癌認知程度的探討. 健康與建築雜誌, 2(2), 36-45. doi:10.6299/jha.2015.2.2.r5.36

黃獻樑, & 程劭儀. (2012). 乳癌的篩檢. 台北市醫師公會會刊, 56(3), 25-27.

林惠文、 顏啟華、應宗和. (2006). 乳癌的篩檢與診斷. 基層醫學, 21(12), 352-358.

季瑋珠、黃俊升、張金堅. (1997). 台灣的乳癌. 中華公共衛生雜誌, 16(1), 62-76. doi:10.6288/cjph1997-16-01-06

李耀泰、陳福民、郭宗正. (2013). 乳癌篩檢的新知. 中華民國內膜異位症婦女協會會刊, 20(7&8), 6-9. doi:10.6498/ea.2013.20(7/8).2