Sierra A E, Potchen E J
Department of Radiology, Michigan State University, East Lansing.
Obstet Gynecol Clin North Am. 1990 Dec;17(4):927-38.
Recognizing the enormous impact that quality breast screening mammography can have on reducing breast cancer deaths, we need to determine when women's and physician's perceived restrictions for mammography examination impede the progress of its use for early cancer detection. A uniform system should emphasize valid communication and education between women and their physicians. Women seek to have a voice in their medical treatment. Yet that responsibility has an emotional price. Physicians and patients must decide together on the most appropriate strategies to enhance communication and adopt specific guidelines they will adhere to, to detect and cure early breast cancer. Women must be educated about breast screening mammography, and physicians must increase their efforts to proclaim its importance. Women need be assured the trend is toward using the most modern mammographic techniques. Quality medical care is medicine's purpose and in women's best interest. At present, no other diagnostic method is equivalent to mammography and capable of providing an equivalent impact on improving the detection and cure rate of breast cancer. Despite medical activities designed to reduce uncertainty in medicine, scientific evidence has not provided systematic answers as to the "best" way to approach issues of quality, cost, accessibility, or communication for breast screening mammography. No particular expert opinion or preference prevails for breast screening protocols. What is needed is adoption of a multidisciplinary approach, educating and motivating women and physicians to participate in breast screening activities. With trends directed toward high-volume breast screening operations, low-cost, quality mammography must be available and be impeccably performed. Some activities are natural subjects for financial quantification. It is objectionable to assume, however, that we can accurately place and agree on dollar amounts alone to represent the costs and benefits of screening mammography. The gaps between practices and attitudes about the benefits, risks, and costs of screening mammography suggest that people are not satisfied with the way physicians, women, influential groups, or regulatory agencies are balancing all of the elements. Better communication must exist between physicians and their peer groups involved in performing responsible mammography. Better communication must be achieved between physicians and women to take advantage of the usefulness of quality breast screening mammography. High-quality screening programs must be linked to third-party reimbursement and to legislation, if we are to make a difference. Screening mammography deserves our medical, economic, social, and political attention and action.
认识到高质量的乳腺筛查钼靶检查对降低乳腺癌死亡率能产生巨大影响，我们需要确定女性和医生所感知到的钼靶检查限制在何时会阻碍其用于早期癌症检测的进程。一个统一的系统应强调女性与其医生之间有效的沟通和教育。女性希望在其医疗过程中有发言权。然而，这种责任是有情感代价的。医生和患者必须共同决定最恰当的策略，以加强沟通并采用他们将遵循的特定指南，来检测和治愈早期乳腺癌。必须对女性进行乳腺筛查钼靶检查的教育，医生必须加大力度宣传其重要性。必须向女性保证，趋势是采用最现代的钼靶技术。优质医疗是医学的目标，且符合女性的最大利益。目前，没有其他诊断方法等同于钼靶检查，也没有其他方法能在提高乳腺癌检测和治愈率方面产生同等影响。尽管开展了旨在减少医学不确定性的医疗活动，但科学证据尚未就乳腺筛查钼靶检查在质量、成本、可及性或沟通问题上的“最佳”方法给出系统答案。对于乳腺筛查方案，没有特定的专家意见或偏好占主导。所需要的是采用多学科方法，教育并激励女性和医生参与乳腺筛查活动。随着趋势朝着大规模乳腺筛查操作发展，必须提供低成本、高质量的钼靶检查且检查要完美无缺地进行。有些活动是进行财务量化的自然对象。然而，假设我们仅通过准确确定金额并达成一致就能代表筛查钼靶检查的成本和收益，这是令人反感的。在筛查钼靶检查的益处、风险和成本方面，实践与态度之间的差距表明人们对医生、女性、有影响力的群体或监管机构平衡所有因素的方式不满意。参与进行负责任的钼靶检查的医生与其同行群体之间必须有更好的沟通。医生与女性之间必须实现更好的沟通，以利用高质量乳腺筛查钼靶检查的效用。如果我们要有所作为，高质量的筛查项目必须与第三方报销及立法挂钩。筛查钼靶检查值得我们在医学、经济及社会和政治方面给予关注并采取行动。
