Hamashima Chisato, Hamashima C Chisato, Hattori Masakazu, Honjo Satoshi, Kasahara Yoshio, Katayama Takafumi, Nakai Masahiro, Nakayama Tomio, Morita Takako, Ohta Koji, Ohnuki Koji, Sagawa Motoyasu, Saito Hiroshi, Sasaki Seiju, Shimada Tomoyuki, Sobue Tomotaka, Suto Akihiko
Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan
Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Jpn J Clin Oncol. 2016 May;46(5):482-92. doi: 10.1093/jjco/hyw008. Epub 2016 Feb 18.
The incidence of breast cancer has progressively increased, making it the leading cause of cancer deaths in Japan. Breast cancer accounts for 20.4% of all new cancers with a reported age-standardized rate of 63.6 per 100 000 women.
The Japanese guidelines for breast cancer screening were developed based on a previously established method. The efficacies of mammography with and without clinical breast examination, clinical breast examination and ultrasonography with and without mammography were evaluated. Based on the balance of the benefits and harms, recommendations for population-based and opportunistic screenings were formulated.
Five randomized controlled trials of mammographic screening without clinical breast examination were identified for mortality reduction from breast cancer. The overall relative risk for women aged 40-74 years was 0.75 (95% CI: 0.67-0.83). Three randomized controlled trials of mammographic screening with clinical breast examination served as eligible evidence for mortality reduction from breast cancer. The overall relative risk for women aged 40-64 years was 0.87 (95% confidence interval: 0.77-0.98). The major harms of mammographic screening were radiation exposure, false-positive cases and overdiagnosis. Although two case-control studies evaluating mortality reduction from breast cancer were found for clinical breast examination, there was no study assessing the effectiveness of ultrasonography for breast cancer screening.
Mammographic screening without clinical breast examination for women aged 40-74 years and with clinical breast examination for women aged 40-64 years is recommended for population-based and opportunistic screenings. Clinical breast examination and ultrasonography are not recommended for population-based screening because of insufficient evidence regarding their effectiveness.
乳腺癌的发病率呈逐年上升趋势，已成为日本癌症死亡的主要原因。乳腺癌占所有新发癌症的20.4%，报告的年龄标准化发病率为每10万名女性中有63.6例。
日本乳腺癌筛查指南是基于先前确立的方法制定的。对单独乳腺钼靶检查、联合临床乳腺检查的乳腺钼靶检查、临床乳腺检查以及联合或不联合乳腺钼靶检查的超声检查的效果进行了评估。基于利弊平衡，制定了针对人群筛查和机会性筛查的建议。
共确定了5项不进行临床乳腺检查的乳腺钼靶筛查随机对照试验，以评估其对降低乳腺癌死亡率的作用。40 - 74岁女性的总体相对风险为0.75（95%可信区间：0.67 - 0.83）。3项联合临床乳腺检查的乳腺钼靶筛查随机对照试验可作为降低乳腺癌死亡率的有效证据。40 - 64岁女性的总体相对风险为0.87（95%置信区间：0.77 - 0.98）。乳腺钼靶筛查的主要危害包括辐射暴露、假阳性病例和过度诊断。虽然发现了2项评估临床乳腺检查对降低乳腺癌死亡率作用的病例对照研究，但未发现评估超声检查用于乳腺癌筛查有效性的研究。
对于人群筛查和机会性筛查，建议对40 - 74岁女性进行不联合临床乳腺检查的乳腺钼靶筛查，对40 - 64岁女性进行联合临床乳腺检查的乳腺钼靶筛查。由于临床乳腺检查和超声检查有效性的证据不足，不建议用于人群筛查。
