Újhelyi M, Pukancsik D, Kelemen P, Kovács E, Kenessey I, Udvarhelyi N, Bak M, Kovács T, Mátrai Z
National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György str. 7-9, 1122 Budapest, Hungary.
National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György str. 7-9, 1122 Budapest, Hungary.
Eur J Surg Oncol. 2016 Dec;42(12):1814-1820. doi: 10.1016/j.ejso.2016.06.403. Epub 2016 Jul 9.
Mammography screening reduces breast cancer mortality by up to 32%. However, some recent studies have questioned the impact of non-palpable breast cancer detection on mortality reduction. The aim of this study was to analyse the clinicopathological and long-term follow-up data of early stage screened and symptomatic breast cancer patients.
The institutional prospectively led database was systematically analysed for breast cancer cases diagnosed via the mammography screening program from 2002 to 2009. As a control group, symptomatic early stage breast cancer patients were collected randomly from the same database and matched for age and follow-up period. All medical records were reviewed retrospectively.
Data from 298 breast cancer patients were collected from 47,718 mammography screenings. In addition, 331 symptomatic breast cancer patients were randomly selected. The screened group presented a significantly lower median tumour size (P < 0.00001). The incidence of negative regional lymph nodes was significantly higher in the screened group (P < 0.0006). The incidence of chemotherapy was 17% higher in the symptomatic group (P = 4*10). At the median follow-up of 65 and 80 months, the screened group did not exhibit better overall (P = 0.717) or disease-free survival (P = 0.081) compared to the symptomatic group.
Our results do not suggest that mammography screening does not reduce breast cancer mortality but the mammography screening did not bring any significant improvement in patient overall or disease-free survival for the early stage breast cancer patients compared to the symptomatic group. The drawback of symptomatic early stage tumours compared to non-palpable tumours could be equalized by modern multimodality oncology treatments.
乳腺钼靶筛查可将乳腺癌死亡率降低达32%。然而，最近一些研究对不可触及乳腺癌的检测对降低死亡率的影响提出了质疑。本研究的目的是分析早期筛查和有症状乳腺癌患者的临床病理及长期随访数据。
对2002年至2009年通过乳腺钼靶筛查项目诊断的乳腺癌病例，系统分析机构前瞻性主导的数据库。作为对照组，从同一数据库中随机收集有症状的早期乳腺癌患者，并按年龄和随访期进行匹配。所有病历均进行回顾性审查。
从47718次乳腺钼靶筛查中收集了298例乳腺癌患者的数据。此外，随机选择了331例有症状的乳腺癌患者。筛查组的肿瘤中位数大小明显更低（P<0.00001）。筛查组区域淋巴结阴性的发生率明显更高（P<0.0006）。有症状组的化疗发生率高17%（P=4×10）。在中位随访65个月和80个月时，与有症状组相比，筛查组在总生存率（P=0.717）或无病生存率方面并未表现出更好的结果（P=0.081）。
我们的结果并不表明乳腺钼靶筛查不能降低乳腺癌死亡率，但与有症状组相比，乳腺钼靶筛查并未给早期乳腺癌患者的总体或无病生存率带来任何显著改善。与不可触及肿瘤相比，有症状的早期肿瘤的缺点可通过现代多模式肿瘤治疗来平衡。
