Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, 4-5062 Pickens Academic Tower, Houston, TX 77030-1402, USA.
Breast. 2013 Aug;22 Suppl 2(0 2):S73-6. doi: 10.1016/j.breast.2013.07.013.
Few medical issues have been as controversial--or as political, at least in the United States-as the role of mammographic screening for breast cancer. The advantages of finding a cancer early seem obvious. Indeed, randomized trials evaluating screening mammography demonstrate a reduction in breast cancer mortality, but the benefits are less than one would hope. Moreover, the randomized trials are themselves subject to criticism, including that they are irrelevant in the modern era because most were conducted before chemotherapy and hormonal therapy became widely used. In this article I chronicle the evidence and controversies regarding mammographic screening, including attempts to assess the relative contributions of screening and therapy in the substantial decreases in breast cancer mortality that have been observed in many countries over the last 20-25 years. I emphasize the trade-off between harms and benefits depending on the woman's age and other risk factors. I also discuss ways for communicating the associated risks to women who have to decide whether screening (and what screening strategy) is right for them.
在医学领域，很少有问题像乳腺癌的乳房 X 光筛查的作用那样具有争议性——至少在美国是这样。早期发现癌症的优势似乎显而易见。事实上，评估筛查性乳房 X 光检查的随机试验确实显示出乳腺癌死亡率的降低，但收益并不像人们所希望的那样大。此外，这些随机试验本身也受到批评，包括它们在现代时代是无关紧要的，因为大多数试验都是在化疗和激素治疗广泛应用之前进行的。在本文中，我记录了有关乳房 X 光筛查的证据和争议，包括评估筛查和治疗在过去 20-25 年间许多国家观察到的乳腺癌死亡率显著下降中的相对贡献的尝试。我强调了根据女性的年龄和其他风险因素，在危害和收益之间进行权衡。我还讨论了向必须决定是否进行筛查（以及哪种筛查策略适合她们）的女性传达相关风险的方法。
