Yip Cheng-Har, Smith Robert A, Anderson Benjamin O, Miller Anthony B, Thomas David B, Ang Eng-Suan, Caffarella Rosemary S, Corbex Marilys, Kreps Gary L, McTiernan Anne
Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Cancer. 2008 Oct 15;113(8 Suppl):2244-56. doi: 10.1002/cncr.23842.
A key determinant of breast cancer outcome in any population is the degree to which cancers are detected at early stages of disease. Populations in which cancers are detected at earlier stages have lower breast cancer mortality rates. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary in October 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for early detection, diagnosis, and treatment in low- and middle-income countries (LMCs). A multidisciplinary panel of experts specifically addressed the implementation of BHGI guidelines for the early detection of disease as they related to resource allocation for public education and awareness, cancer detection methods, and evaluation goals. Public education and awareness are the key first steps, because early detection programs cannot be successful if the public is unaware of the value of early detection. The effectiveness and efficiency of screening modalities, including screening mammography, clinical breast examination (CBE), and breast self-examination, were reviewed in the context of resource availability and population-based need by the panel. Social and cultural barriers should be considered when early detection programs are being established, and the evaluation of early detection programs should include the use of well developed, methodologically sound process metrics to determine the effectiveness of program implementation. The approach and scope of any screening program will determine the success of any early detection program as measured by cancer stage at diagnosis and will drive the breadth of resource allocation needed for program implementation.
在任何人群中，乳腺癌预后的一个关键决定因素是癌症在疾病早期被检测出的程度。癌症在早期阶段被检测出的人群，其乳腺癌死亡率较低。2007年10月，全球乳腺癌防治倡议（BHGI）在匈牙利布达佩斯举行了第三届全球峰会，汇聚了国际知名专家，以探讨在低收入和中等收入国家（LMCs）实施乳腺癌早期检测、诊断和治疗的医疗保健指南。一个多学科专家小组专门讨论了BHGI疾病早期检测指南的实施情况，这些指南涉及公共教育和宣传、癌症检测方法以及评估目标的资源分配。公共教育和宣传是关键的第一步，因为如果公众没有意识到早期检测的价值，早期检测计划就不可能成功。该小组在资源可用性和基于人群的需求背景下，对包括乳腺钼靶筛查、临床乳腺检查（CBE）和乳房自我检查在内的筛查方式的有效性和效率进行了审查。在建立早期检测计划时应考虑社会和文化障碍，并且早期检测计划的评估应包括使用完善、方法合理的过程指标来确定计划实施的有效性。任何筛查计划的方法和范围将决定任何早期检测计划的成功与否，成功与否以诊断时的癌症阶段来衡量，并将推动计划实施所需的资源分配广度。
