Women's College Research Institute, Women's College Hospital, Toronto, ON, M5G 1N8, Canada.
Breast Cancer Res Treat. 2011 Jul;128(1):259-66. doi: 10.1007/s10549-010-1318-9. Epub 2011 Jan 4.
If mammographic screening is to be recommended to women aged <50, it is necessary that mammographic screening leads to the detection of small cancers and that the survival rate of young women with small cancers is superior to that of women with larger cancers. We reviewed the survival experience of 2,173 patients with invasive breast cancer. There were 392 cancer-specific deaths in the cohort after a mean of 8.9 years of follow-up. We estimated the effects of young age (age <50) of tumor size (in cm) and of mammogram detected (vs. palpable) on breast cancer survival in the cohort. Young age, tumor size >2 cm and tumor palpability were strong and independent predictors of breast cancer mortality in the cohort. The 10-year survival rate for young women with small mammogram-detected breast cancers (<1 cm) was 94%, compared to 86% for women with palpable cancers in the same size group (P < 0.01). Women with a small non-palpable breast cancer that is diagnosed through a mammogram experience very good survival, compared to women with a palpable breast cancer of similar size. Our findings suggest that mammography preferentially detects cancers with good prognosis and calls into question the assumption that detecting breast cancers when they are small by mammography will impact upon mortality from breast cancer.
如果要向 <50 岁的女性推荐乳腺 X 线筛查，就必须保证乳腺 X 线筛查能够发现小癌症，并且年轻的小癌症患者的生存率要优于大癌症患者。我们回顾了 2173 例浸润性乳腺癌患者的生存经验。在平均 8.9 年的随访后，该队列中有 392 例癌症特异性死亡。我们评估了肿瘤大小（以厘米计）和乳腺 X 线摄影检测（与可触及相比）对该队列中乳腺癌生存的影响。年轻（<50 岁）、肿瘤大小>2cm 和肿瘤可触及是该队列中乳腺癌死亡率的强且独立的预测因素。在<1cm 的小乳腺 X 线摄影检测乳腺癌的年轻女性中，10 年生存率为 94%，而在相同大小组中可触及癌症的女性为 86%（P<0.01）。通过乳腺 X 线摄影诊断的小、不可触及的乳腺癌女性的生存情况非常好，与具有相似大小的可触及乳腺癌女性相比。我们的发现表明，乳腺 X 线摄影优先检测预后良好的癌症，并对通过乳腺 X 线摄影在癌症较小时进行检测将影响乳腺癌死亡率的假设提出质疑。
