Keith Louis G, Oleszczuk Jaroslaw J, Laguens Martin
Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA.
J Womens Health Gend Based Med. 2002 Jan-Feb;11(1):17-25. doi: 10.1089/152460902753473417.
Breast cancer is an equal opportunity killer in that as many as 60%-70% of breast cancer patients have no obvious risk factor(s). Thus, the continued reliance on the importance of risk factors to initiate screening programs may inhibit further inquiry into better diagnostic and prognostic indicators. An extensive review of past and recent literature reveals that mammography is not an objective examination. Its use as a screening tool is facilitated among women 40 years old and older whose breast tissue is primarily fatty and provides better visualization. Younger women are not generally advised to use mammography because of its potentially hazardous effects associated with repeated use of radiation. More importantly, regardless of patient age, radiologists interpret mammograms, and different degrees of interpretation error exist for different radiologists as well as for the same radiologist performing the analysis after a period of time. Thus, the use of mammography as the sole screening tool does not provide patients or physicians with a sense of confidence about sensitivity and specificity. Further, recent enthusiasm to promote mammography screening may give women unrealistic expectations, leading them to falsely believe that a negative examination is assurance that cancer is not present in its earliest detectable stage. We propose to supplement the physical examination and mammography with a third screening modality based on thermal detection monitors. This is a noninvasive and nonradiogenic tool and might enable clinicians to provide patients with every opportunity for early diagnosis.
乳腺癌是一种机会均等的杀手，因为多达60%-70%的乳腺癌患者没有明显的风险因素。因此，持续依赖风险因素对于启动筛查项目的重要性，可能会抑制对更好的诊断和预后指标的进一步探究。对过去和近期文献的广泛回顾显示，乳房X光检查并非客观的检查。对于40岁及以上的女性，乳房X光检查作为一种筛查工具更易实施，这些女性的乳房组织主要为脂肪组织，能提供更好的图像。由于反复使用辐射存在潜在危害，一般不建议年轻女性使用乳房X光检查。更重要的是，无论患者年龄如何，乳房X光片由放射科医生解读，不同的放射科医生以及同一放射科医生在一段时间后进行分析时，都存在不同程度的解读误差。因此，将乳房X光检查作为唯一的筛查工具，并不能让患者或医生对其敏感性和特异性有信心。此外，近期对推广乳房X光检查筛查的热情可能会让女性产生不切实际的期望，导致她们错误地认为阴性检查就能确保在最早可检测阶段不存在癌症。我们建议用基于热检测监测仪的第三种筛查方式来补充体格检查和乳房X光检查。这是一种非侵入性且无辐射的工具，可能使临床医生为患者提供一切早期诊断的机会。
