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昼夜节律紊乱:一种新的乳腺癌标志物。

Circadian rhythm chaos: a new breast cancer marker.

作者信息

Keith L G, Oleszczuk J J, Laguens M

机构信息

Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA.

出版信息

Int J Fertil Womens Med. 2001 Sep-Oct;46(5):238-47.

Abstract

The most disappointing aspect of breast cancer treatment as a public health issue has been the failure of screening to improve mortality figures. Since treatment of late-stage cancer has indeed advanced, mortality can only be decreased by improving the rate of early diagnosis. From the mid-1950s to the mid-1970s, it was expected that thermography would hold the key to breast cancer detection, as surface temperature increases overlying malignant tumors had been demonstrated by thermographic imaging. Unfortunately, detection of the 1-3 degrees C thermal differences failed to bear out its promise in early identification of cancer. In the intervening two-and-a-half decades, three new factors have emerged: it is now apparent that breast cancer has a lengthy genesis; a long-established tumor-even one of a certain minimum size-induces increased arterial/capillary vascularity in its vicinity; and thermal variations that characterize tissue metabolism are circadian ("about 24 hours") in periodicity. This paper reviews the evidence for a connection between disturbances of circadian rhythms and breast cancer. Furthermore, a scheme is proposed in which circadian rhythm "chaos" is taken as a signal of high risk for breast cancer even in the absence of mammographic evidence of neoplasm or a palpable tumor. Recent studies along this line suggest that an abnormal thermal sign, in the light of our present knowledge of breast cancer, is ten times as important an indication as is family history data.

摘要

作为一个公共卫生问题,乳腺癌治疗最令人失望的方面在于筛查未能提高死亡率。由于晚期癌症的治疗确实取得了进展,因此只有提高早期诊断率才能降低死亡率。从20世纪50年代中期到70年代中期,人们曾期望热成像技术能成为乳腺癌检测的关键,因为热成像已证明恶性肿瘤上方的体表温度会升高。不幸的是,检测1至3摄氏度的温差未能在癌症早期识别中兑现其承诺。在这二十五年间,出现了三个新因素:现在很明显乳腺癌有很长的发生期;一个长期存在的肿瘤——即使是达到一定最小尺寸的肿瘤——会在其附近诱导动脉/毛细血管血管生成增加;以及表征组织代谢的热变化具有昼夜节律(“约24小时”)周期性。本文回顾了昼夜节律紊乱与乳腺癌之间存在关联的证据。此外,还提出了一个方案,即即使在没有乳腺X线摄影显示肿瘤或可触及肿瘤的证据的情况下,将昼夜节律“紊乱”视为乳腺癌高风险的信号。沿着这条线的近期研究表明,根据我们目前对乳腺癌的了解,异常热信号作为一种指示比家族病史数据重要十倍。

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