Obstet Gynecol. 2017 Jul;130(1):e1-e16. doi: 10.1097/AOG.0000000000002158.
Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4).Breast cancer risk assessment is very important for identifying women who may benefit from more intensive breast cancer surveillance; however, there is no standardized approach to office-based breast cancer risk assessment in the United States. This can lead to missed opportunities to identify women at high risk of breast cancer and may result in applying average-risk screening recommendations to high-risk women. Risk assessment and identification of women at high risk allow for referral to health care providers with expertise in cancer genetics counseling and testing for breast cancer-related germline mutations (eg, BRCA), patient counseling about risk-reduction options, and cascade testing to identify family members who also may be at increased risk.The purpose of this Practice Bulletin is to discuss breast cancer risk assessment, review breast cancer screening guidelines in average-risk women, and outline some of the controversies surrounding breast cancer screening. It will present recommendations for using a framework of shared decision making to assist women in balancing their personal values regarding benefits and harms of screening at various ages and intervals to make personal screening choices from within a range of reasonable options. Recommendations for women at elevated risk and discussion of new technologies, such as tomosynthesis, are beyond the scope of this document and are addressed in other publications of the American College of Obstetricians and Gynecologists (ACOG) (5-7).
乳腺癌是美国女性中最常被诊断出的癌症，也是美国女性癌症死亡的第二大主要原因（1）。从40岁开始定期进行乳腺钼靶筛查可降低平均风险女性的乳腺癌死亡率（2）。然而，筛查也会因假阳性检测结果和对生物学惰性病变的过度诊断而使女性受到伤害。在权衡益处和危害方面的差异导致了主要指南在平均风险女性开始筛查的年龄、停止筛查的年龄以及推荐乳腺钼靶筛查的频率等方面存在差异（2 - 4）。乳腺癌风险评估对于识别可能从更强化的乳腺癌监测中获益的女性非常重要；然而，在美国，基于办公室的乳腺癌风险评估没有标准化方法。这可能导致错过识别乳腺癌高风险女性的机会，并可能导致将平均风险筛查建议应用于高风险女性。风险评估和识别高风险女性有助于将她们转诊给在癌症遗传咨询和乳腺癌相关种系突变（如BRCA）检测方面具有专业知识的医疗保健提供者，为患者提供关于降低风险选择的咨询，并进行级联检测以识别可能也有更高风险的家庭成员。本实践公告的目的是讨论乳腺癌风险评估，回顾平均风险女性的乳腺癌筛查指南，并概述围绕乳腺癌筛查的一些争议。它将提出使用共同决策框架的建议，以帮助女性在不同年龄和筛查间隔权衡筛查的益处和危害方面的个人价值观，从而在一系列合理选项中做出个人筛查选择。针对高风险女性的建议以及对新技术（如断层合成）的讨论超出了本文范围，在美国妇产科医师学会（ACOG）的其他出版物中有涉及（5 - 7）。
