Knutson Doug, Steiner Elizabeth
The Ohio State University, Department of Family Medicine, Columbus, Ohio 43201, USA.
Am Fam Physician. 2007 Jun 1;75(11):1660-6.
Breast cancer is one of the most significant health concerns in the United States. Recent reviews have questioned the value of traditional breast cancer screening methods. Breast self-examination has been shown not to improve cancer-specific or all-cause mortality in large studies, but it is commonly advocated as a noninvasive screen. Patients who choose to perform self-examination should be trained in appropriate technique and follow-up. The contribution of the clinical breast examination to early detection is difficult to determine, but studies show that sensitivity is highly dependent on time taken to do the examination. Up to 10 percent of cancers are mammographically silent but evident on clinical breast examination. The U.S. Preventive Services Task Force recommends mammography for women older than 40 years who are in good health, but physicians should consider that sensitivity is lower for younger women. Digital mammography is somewhat more sensitive in younger women and women with dense breasts, but outcome studies are lacking. Although magnetic resonance imaging shows promise as a screening tool in some high-risk women, it is not currently recommended for general screening because of high false-positive rates and cost. The American Cancer Society recommends annual magnetic resonance imaging as an adjunct to screening mammography in high-risk women 30 years and older.
乳腺癌是美国最重要的健康问题之一。最近的综述对传统乳腺癌筛查方法的价值提出了质疑。在大型研究中，乳房自我检查已被证明并不能提高癌症特异性死亡率或全因死亡率，但它通常被倡导为一种非侵入性筛查方法。选择进行自我检查的患者应接受适当技术和随访方面的培训。临床乳房检查对早期发现的贡献难以确定，但研究表明，其敏感性高度依赖于检查所花费的时间。高达10%的癌症在乳房X光检查中未显示异常，但在临床乳房检查中却很明显。美国预防服务工作组建议，40岁以上健康状况良好的女性进行乳房X光检查，但医生应考虑到年轻女性的敏感性较低。数字乳房X光检查在年轻女性和乳房致密的女性中敏感性略高，但缺乏结果研究。尽管磁共振成像在一些高危女性中作为筛查工具显示出前景，但由于假阳性率高和成本高，目前不建议用于一般筛查。美国癌症协会建议，30岁及以上的高危女性每年进行一次磁共振成像检查，作为乳房X光筛查的辅助手段。
