患者自我发现的乳腺癌（BC）及相关特征的持续呈现对研究还未得到充分关注。在1990年至2019年的一项大型机构队列研究中，对第一次发生的0-IV期乳腺癌患者（n = 15,827）进行了诊断方法（患者自我发现[PtDBC] [n = 5844]；乳腺X线检查发现[MamDBC] [非诊断性] [n = 9248]；和医生发现[PhysDBC] [n = 736]）以及患者和肿瘤特征，包括年龄、种族、TNM分期和激素受体状态进行了回顾。采用Pearson χ2检验进行双变量比较，采用 logistic 回归分析患者自我发现相关因素。在1990年至2019年的队列中，年龄在50-74岁之间的比例（55%-63%; p < .001）和非白人种族（9%-37%; p < .001）随着时间推移而增加。患者自我发现的比例随时间减少，但案例数增加（1990-1999年：44% [n = 1399]; 2010-2019年：34% [n = 2349]; p < .001）。除0期外，患者自我发现的比例随时间从47%下降至41%（p < .001）。在2010年至2019年期间，21%的案例为0期，其中91%为乳腺X线检查发现（n = 1439）。70%的自我发现案例为Ⅱ-Ⅳ期（Ⅱ期44%，Ⅲ期20%，Ⅳ期6%，p < .001）。在经过调整的 logistic 回归分析中，患者自我发现的几率随时间减少（2000-2009年：OR，.65 [95% CI, .58-.72]; 2010-2019年：OR，.54 [95% CI, .49-.60]），年龄<40岁的几率比为15.81，黑人和其他非白人种族的几率增加了50%。患者自我发现的相对比例在1990-1999年之后稳定在34%-40%。患者自我发现的案例数量在随后的几年（2000-2019年）有所增加，并且一直处于较高分期。间隔期乳腺癌、乳腺X线筛查的接受情况、乳腺健康意识超出筛查准则的年龄组以及服务不足的经济社会群体可能与持续发生的患者自我发现乳腺癌的发病率有关。在经过几十年的乳腺X线筛查可用性后，我们的机构队列研究表明，自我发现的乳腺癌的发病率从44%下降至34%的持续水平。患者自我发现乳腺癌的持续存在对于没有明确诊断路径的年轻和年长妇女以及其照顾者来说是一个困难的情况，这些患者通常表现出更高的分期和更具致命性的特征。需要更及时的诊断和治疗，包括乳腺健康意识、及时就诊乳腺问题、面向年轻和少数群体的外展工作，以及为自我发现的乳腺癌提供专门的培训和护理服务。© 2023 The Authors. 由 Wiley Periodicals LLC 代表美国癌症协会出版的《癌症》杂志发表

The continued presentation of patient-detected breast cancer (BC) and associated characteristics over time is understudied.In a large institutional cohort of first primary stage 0-IV patients with BC in 1990-2019 (n = 15,827), diagnostic method (patient-detected [PtDBC] [n = 5844]; mammography-detected [MamDBC] [nondiagnostic] [n = 9248]; and physician-detected [PhysDBC] [n = 736]) and patient and tumor characteristics including age, race, TNM stage, and hormone-receptor status were reviewed. Pearson χ2 tests for bivariate comparisons and logistic regression for patient detection-associated factors were used.In a cohort from 1990 to 2019, the proportion aged 50-74 years (55%-63%; p < .001) and non-White race (9%-37%; p < .001) increased over time. Percentage PtDBC decreased over time but case numbers increased (1990-1999: 44% [n = 1399]; 2010-2019: 34% [n = 2349]; p < .001). Excluding stage 0, PtDBC declined from 47% to 41% over time (p < .001). In 2010-2019, 21% of cases were stage 0, 91% of which were mammography detected (n = 1439). Seventy percent of patient-detected cases were stage II-IV (stage II, 44%; stage III, 20%; stage IV, 6%; p < .001). In adjusted logistic regression, the odds of PtDBC decreased over time (2000-2009: odds ratio [OR], .65 [95% CI, .58-.72]; 2010-2019: OR, .54 [95% CI, .49-.60]), with age <40 years OR, 15.81, and Black and non-White other at 50% increased risk.The relative proportion of PtDBC decreased to a constant 34%-40% of total cases after 1990-1999. PtDBC case numbers increased in subsequent years (2000-2019), and were consistently higher stage. Interval cancers, mammography-screening uptake, breast health awareness of age groups outside screening guidelines, and underserved socioeconomic groups may be related to the continued significant PtDBC incidence.After decades of mammography-screening availability, symptomatic patient-detected breast cancer declined over time from 44% to a persistent rate of 34% in our institutional cohort. The persistence of patient-detected breast cancer over time presents a difficult situation for patients and care givers without clear diagnosis pathways for younger and older women outside recommended screening guidelines, who often present with higher stage and more lethal characteristics. More timely diagnosis and treatment including breast health awareness, prompt presentation of breast problems, outreach to younger age and minority groups, and provision of specialized training and care delivery for symptomatic patient-detected breast cancer are needed.© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.