Department of Senology, CHU of Liège, avenue de l'hôpital B35, Liège, Belgium.
Maturitas. 2012 Nov;73(3):202-5. doi: 10.1016/j.maturitas.2012.08.004. Epub 2012 Sep 14.
Publicly organized population breast cancer screening is presently hotly debated. Indeed, population screening is poorly effective, induces harms in a healthy population and is costly. However, stopping all kind of screening of low- and average-risk women would be problematic as about 70% of breast cancers are diagnosed in those subgroups, and maintaining current population screening in high-risk women would be insufficient. We propose herein a review about the advantages and the inconvenience of individualized screening. The latter could be a more efficient strategy. The principles of individualized screening are (a) to start from the age at which the breast cancer risk is equal to that for an average women aged 50 years, (b) to stop when the risk of co-mortality exceeds the risk of breast cancer mortality, (c) to adapt the exams frequency and the imaging modalities to the individual risk and to the breast density, (d) to reassess regularly and individually the screening strategy, and (e) to discuss honestly with each woman in order to help her to decide if she participates or not.
目前，公众组织的人群乳腺癌筛查备受争议。事实上，人群筛查效果不佳，会对健康人群造成伤害，且费用高昂。然而，停止对低危和中危女性的所有类型筛查可能会产生问题，因为约 70%的乳腺癌发生在这些亚组中，而维持高危女性的现行人群筛查也将是不够的。本文综述了个体化筛查的优势和不便之处。后者可能是一种更有效的策略。个体化筛查的原则包括：（a）从乳腺癌风险等同于 50 岁普通女性的年龄开始筛查；（b）当共存死亡率风险超过乳腺癌死亡率风险时停止筛查；（c）根据个体风险和乳房密度调整检查频率和影像学方式；（d）定期对筛查策略进行个体化重新评估；（e）与每位女性进行坦诚讨论，以帮助她决定是否参与筛查。
