van Asperen C J, de Bock G H, van der Horst F, de Koning H J, Rutgers E J
Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden, Afd. Klinisch Genetisch Centrum Leiden.
Ned Tijdschr Geneeskd. 2001 Jan 20;145(3):120-5.
For healthy women, without malignancies in their personal histories, a positive family history for breast cancer is the single indication for individual breast surveillance outside the population screening. Management of women is based on individual risk assessment. A cumulative risk of 20% and more, as a result of a positive family history, will in practice be an indication for breast surveillance. This threshold is not evidence-based yet, nor are data available on the benefits of this surveillance efficacy. When a personal cumulative risk of more than 30% exists to develop breast cancer, a consultation with a clinical geneticist involved in a family cancer clinic should be offered. Surveillance of women with a high-risk cumulative risk should preferably be included in a prospective study design. Only in this way will data about compliance and the estimates of different ways of surveillance become available. There is no convincing evidence that population screening for women aged 40-49 years does lead to important mortality reduction in combination with a good balance between pros and cons for the women involved. Women in the age category 50-75 years, with breast cancer in their personal histories, who are not followed anymore, should be informed by their specialist about participating (again) in the population breast screening. There is no evidence of mortality reduction as a result of breast self-examination nor of palpation performed by a physician. However, awareness of the own body can be useful for early recognition of breast abnormalities; it may reduce the delay between the first recognizable symptom and the subsequently initiated therapy.
对于无个人恶性肿瘤病史的健康女性，乳腺癌家族史阳性是在人群筛查之外进行个体乳房监测的唯一指征。对女性的管理基于个体风险评估。由于家族史阳性导致的累积风险达到20%及以上，实际上将成为乳房监测的指征。这一门槛尚无循证依据，也没有关于这种监测效果益处的数据。当个人患乳腺癌的累积风险超过30%时，应建议其咨询参与家庭癌症诊所的临床遗传学家。对累积风险高的女性进行监测最好纳入前瞻性研究设计。只有这样才能获得关于依从性以及不同监测方式评估的数据。没有令人信服的证据表明，40至49岁女性的人群筛查与所涉女性的利弊良好平衡相结合能显著降低死亡率。50至75岁有个人乳腺癌病史但不再接受随访的女性，应由其专科医生告知其再次参与人群乳房筛查。没有证据表明乳房自我检查或医生触诊能降低死亡率。然而，对自身身体的了解有助于早期发现乳房异常；这可能会减少首次可识别症状与随后开始治疗之间的延迟。
