Diratzouian Hasmik, Freedman Gary M, Hanlon Alexandra L, Eisenberg Debra F, Anderson Penny R
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Clin Breast Cancer. 2005 Oct;6(4):330-3. doi: 10.3816/CBC.2005.n.036.
A recent trial called into question the efficacy of breast self-examination. We studied the characteristics and outcome of women in whom physical examination (PE) was their sole method of breast cancer detection.
From 1970 to 1998, 1752 women with stage I/II breast cancer underwent breast-conserving surgery and radiation. Two hundred sixty patients (15%) had abnormal PE finding as their sole method of cancer detection at the time of diagnosis, 723 (41%) had only mammographic findings, and 762 (43%) had both.
Detection by PE was associated with younger age, larger tumor size, positive axillary nodes, and use of chemotherapy. For women < 40 years of age, PE was the sole method of detection in 40% of cases. The patients for whom PE was the sole method of detection had equivalent 10-year locoregional control and overall survival (OS) compared with patients whose cancer was detected by mammography. Detection by PE was not an independent predictor for outcome on multivariate analysis. The use of tamoxifen (P = 0.0089) was the sole predictor for improved locoregional control. Tumor stage (P = 0.0001), nodal status (P = 0.039), age (P = 0.0112) and lymphovascular invasion (P = 0.0399) were negative predictors of OS.
Although associated with younger age, larger tumors, and more frequent node positivity, in this study detection by PE did not confer worse outcome. This may be because of the increased use of chemotherapy in these patients. Physical examination remains an important method of detection of breast cancer, particularly for younger women for whom mammography is less sensitive and not performed as frequently.
最近的一项试验对乳房自我检查的有效性提出了质疑。我们研究了那些将体格检查（PE）作为乳腺癌唯一检测方法的女性的特征及预后情况。
1970年至1998年期间，1752例I/II期乳腺癌女性接受了保乳手术及放疗。260例患者（15%）在诊断时以体格检查异常结果作为癌症的唯一检测方法，723例（41%）仅有乳腺X线摄影检查结果，762例（43%）两者皆有。
通过体格检查发现癌症与患者年龄较轻、肿瘤体积较大、腋窝淋巴结阳性以及化疗的使用有关。对于年龄小于40岁的女性，40%的病例中体格检查是唯一的检测方法。与通过乳腺X线摄影检查发现癌症的患者相比，以体格检查作为唯一检测方法的患者10年局部区域控制率和总生存率（OS）相当。在多变量分析中，通过体格检查发现癌症并非预后的独立预测因素。他莫昔芬的使用（P = 0.0089）是局部区域控制改善的唯一预测因素。肿瘤分期（P = 0.0001）、淋巴结状态（P = 0.039）、年龄（P = 0.0112）和淋巴管浸润（P = 0.0399）是总生存率的负性预测因素。
尽管在本研究中通过体格检查发现癌症与患者年龄较轻、肿瘤较大以及淋巴结阳性更为常见有关，但并未导致更差的预后。这可能是因为这些患者化疗的使用增加。体格检查仍然是检测乳腺癌的重要方法，特别是对于年轻女性，乳腺X线摄影对她们的敏感性较低且检查频率不高。
