Lerner B H
Center for the Study of Society and Medicine, Columbia University, New York, NY 10032, USA.
Am J Public Health. 1999 Jun;89(6):938-44. doi: 10.2105/ajph.89.6.938.
Women who test positive for a genetic breast cancer marker may have more than a 50% chance of developing the disease. Although past screening technologies have sought to identify actual breast cancers, as opposed to predisposition, the history of screening may help predict the societal response to genetic testing. For decades, educational messages have encouraged women to find breast cancers as early as possible. Such messages have fostered the popular assumption that immediately discovered and treated breast cancers are necessarily more curable. Research, however, has shown that screening improves the prognosis of some--but not all--breast cancers, and also that it may lead to unnecessary interventions. The dichotomy between the advertised value of early detection and its actual utility has caused particular controversy in the United States, where the cultural climate emphasizes the importance of obtaining all possible medical information and acting on it. Early detection has probably helped to lower overall breast cancer mortality. But it has proven hard to praise aggressive screening without exaggerating its merits. Women considering genetic breast cancer testing should weight the benefits and limitations of early knowledge.
携带遗传性乳腺癌标志物检测呈阳性的女性患该病的几率可能超过50%。尽管过去的筛查技术旨在识别实际的乳腺癌，而非易感性，但筛查的历史可能有助于预测社会对基因检测的反应。几十年来，教育信息一直鼓励女性尽早发现乳腺癌。这些信息助长了一种普遍的观念，即立即发现并治疗的乳腺癌必然更易治愈。然而，研究表明，筛查改善了部分（而非全部）乳腺癌的预后，而且筛查还可能导致不必要的干预。早期检测所宣称的价值与其实际效用之间的二分法在美国引发了特别的争议，在美国，文化氛围强调获取所有可能的医疗信息并据此采取行动的重要性。早期检测可能有助于降低总体乳腺癌死亡率。但事实证明，不夸大积极筛查的优点就很难对其加以赞扬。考虑进行遗传性乳腺癌检测的女性应该权衡早期知晓的益处和局限性。
