1 Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106.
AJR Am J Roentgenol. 2014 Feb;202(2):282-8. doi: 10.2214/AJR.13.11382.
The purpose of this study is to determine whether there were significant differences with respect to treatment recommendations, stage at diagnosis, and identification of high-risk lesions for women 40-49 years old undergoing screening mammography (screened) compared to women with a symptom needing a diagnostic evaluation (nonscreened).
We reviewed the pathology results of all imaging-guided biopsies performed at the three breast center locations of University Hospitals Case Medical Center from January 1, 2008, to December 31, 2011. In patients diagnosed with a high-risk lesion or breast cancer, the reason for presentation, pathology, tumor size, stage, receptor characteristics, and treatment were recorded. The chi-square test was used for statistical analysis.
Of 230 primary breast cancers, 149 were in the screened group and 81 were considered nonscreened. Nonscreened patients were more likely to undergo chemotherapy (p = 0.042). Eighty-one percent of the high-risk lesions were diagnosed in the screened patients. Screened patients with cancer were significantly more likely to receive a diagnosis at earlier stages (p = 0.001), to have negative axillary lymph nodes (p = 0.005), and to have smaller tumors (p < 0.001).
In addition to the benefits of receiving a diagnosis at earlier stages, with smaller tumors and node negativity, patients with breast cancer undergoing screening mammography aged 40-49 years are less likely to require chemotherapy and its associated morbidities. The majority of high-risk lesions were diagnosed in the screened group, which may lead to the benefit of chemoprevention, lowering their risk of subsequent breast cancer, or screening with MRI, which may diagnose future mammographically occult malignancies.
本研究旨在确定在接受筛查性乳房 X 光检查（筛查）的 40-49 岁女性与因症状需要诊断评估（非筛查）的女性相比，在治疗建议、诊断时的分期以及高危病变的识别方面是否存在显著差异。
我们回顾了 2008 年 1 月 1 日至 2011 年 12 月 31 日期间，在凯斯西储大学医院三个乳房中心进行的所有影像学引导活检的病理结果。在诊断为高危病变或乳腺癌的患者中，记录了就诊原因、病理、肿瘤大小、分期、受体特征和治疗情况。采用卡方检验进行统计学分析。
在 230 例原发性乳腺癌中，149 例为筛查组，81 例为非筛查组。非筛查组患者更有可能接受化疗（p=0.042）。81%的高危病变在筛查组中得到诊断。筛查组的癌症患者更有可能在早期阶段被诊断（p=0.001），腋窝淋巴结阴性（p=0.005），肿瘤更小（p<0.001）。
除了在更早的阶段、肿瘤更小和淋巴结阴性时获得诊断的益处外，接受筛查性乳房 X 光检查的 40-49 岁乳腺癌患者更不可能需要化疗及其相关的并发症。大多数高危病变在筛查组中得到诊断，这可能带来化学预防的益处，降低她们随后患乳腺癌的风险，或者进行 MRI 筛查，这可能诊断未来乳房 X 光检查隐匿性恶性肿瘤。
