Stacey-Clear A, McCarthy K A, Hall D A, Pile-Spellman E, White G, Hulka C, Whitman G J, Mahoney E, Kopans D B
Department of Radiology, Massachusetts General Hospital, Boston 02114.
Lancet. 1992 Oct 24;340(8826):991-4. doi: 10.1016/0140-6736(92)93008-b.
Great uncertainty exists about the benefit of detecting breast cancer by mammography in women under 50 years of age. We have reviewed the survival of patients aged 49 years or less whose cancers were detected by mammography alone. 117 women under the age of 50 years were diagnosed with breast cancer between 1978 and 1991 based only on an abnormal mammogram. Ductal carcinoma in-situ (DCIS) was found in 47 (40%) of these women, whilst 70 (60%) had infiltrating ductal or infiltrating lobular carcinomas. During the same interval, 928 women in this age group presented with palpable breast cancer. DCIS was diagnosed in 82 (9%) of these women, whilst 846 (91%) had infiltrating carcinoma. Among the infiltrating cancers detected by mammography alone, 50% were stage I, whilst only 30% of the women with palpable cancers were stage I. Five-year survival for all mammographically detected cancer patients was 95%, whereas for women with palpable cancers the survival was 74% (p < 0.00005). If DCIS is not included, the corresponding survivals are 91% for mammographically detected infiltrating cancers and 72% for palpable infiltrating cancers. Only 1 woman who died among those with palpable cancer had had a mammogram before diagnosis. Our data contradict the suggestion that women under 50 are put at a survival disadvantage by undergoing mammography. We believe that investigators who have reported negative results in this age group must examine other causes for their results.
对于50岁以下女性通过乳房X线摄影术检测乳腺癌的益处存在很大不确定性。我们回顾了仅通过乳房X线摄影术检测出癌症的49岁及以下患者的生存率。1978年至1991年间，117名50岁以下女性仅基于乳房X线摄影异常被诊断为乳腺癌。其中47名（40%）女性患有导管原位癌（DCIS），而70名（60%）患有浸润性导管癌或浸润性小叶癌。在同一时期，该年龄组有928名女性出现可触及的乳腺癌。这些女性中有82名（9%）被诊断为DCIS，而846名（91%）患有浸润性癌。在仅通过乳房X线摄影术检测出的浸润性癌症中，50%为I期，而在可触及癌症的女性中只有30%为I期。所有通过乳房X线摄影术检测出癌症的患者的五年生存率为95%，而可触及癌症的女性生存率为74%（p<0.00005）。如果不包括DCIS，通过乳房X线摄影术检测出的浸润性癌症的相应生存率为91%，可触及浸润性癌症的生存率为72%。在可触及癌症患者中死亡的只有1名女性在诊断前进行过乳房X线摄影。我们的数据与50岁以下女性接受乳房X线摄影会在生存方面处于劣势的观点相矛盾。我们认为，在这个年龄组报告了负面结果的研究人员必须检查其结果产生的其他原因。
