Wirman J A
Crit Rev Oncol Hematol. 1985;3(1):35-74. doi: 10.1016/s1040-8428(85)80039-1.
We can draw the following conclusions about minimal breast cancer: The concept of minimal breast cancer as a stage of cancer that is 95% curable is a valid one, if minimal breast cancer is defined by strict parameters. Both 0.5 and 1.0 cm have been defined as the upper limit of size for minimal invasive cancer. Some data indicate that 0.5 cm is the preferable dividing line and that 1-cm cancers are no longer minimal. Other data suggest that the most important factor is axillary lymph node status. One-centimeter cancers are probably 95% curable if axillary lymph nodes are negative. Cancers of 0.5 cm and smaller in size are probably not 95% curable if axillary lymph nodes are involved. Carcinoma in situ appears to be highly curable, even if axillary lymph nodes are involved. Minimal breast cancer should include lobular carcinoma in situ (lobular neoplasia) and ductal carcinoma in situ regardless of nodal status, and (tentatively) invasive carcinoma smaller than 1 cm in total diameter, if axillary lymph nodes are not involved. Many cases of minimal breast cancer are asymptomatic. If special screening is not used, less than 10% of women with breast cancer will be at the minimal stage when diagnosed. Screening programs can increase this ratio to as much as one third of patients, perhaps even more. While serious questions about cost effectiveness of mass screening remain, screening programs appear to represent the best way of detecting minimal breast cancer. Screening programs should include careful history and physical examination, of course. The role of mammography is still controversial. It is probable that at least 50% of all minimal cancers would be missed without mammography. After a period of significant worry about the risk of radiation, opinion seems to be changing now and many authors are willing to accept the fact that mammography is of more benefit than risk for younger women. The HIP study would indicate that the risk/benefit ratio becomes favorable at age 50. Many authorities would now comfortably include mammography in the screening of women age 40 or older. Some authors believe that the benefits of mammography outweight the risks for patients of all ages. This question needs to be tested, and several randomized prospective clinical trials now in progress are doing just that. The legitimate worry over the risks of mammography should not obscure a very important fact.(ABSTRACT TRUNCATED AT 400 WORDS)
关于微小乳腺癌，我们可以得出以下结论：如果通过严格的参数定义微小乳腺癌，那么将其视为治愈率达95%的癌症阶段这一概念是合理的。0.5厘米和1.0厘米都曾被定义为微小浸润癌的大小上限。一些数据表明，0.5厘米是更合适的分界线，1厘米的癌症不再属于微小癌。其他数据则提示，最重要的因素是腋窝淋巴结状态。如果腋窝淋巴结阴性，1厘米的癌症治愈率可能为95%。如果腋窝淋巴结受累，0.5厘米及更小的癌症治愈率可能达不到95%。原位癌似乎即便腋窝淋巴结受累也具有很高的治愈率。微小乳腺癌应包括小叶原位癌（小叶肿瘤）和导管原位癌，无论淋巴结状态如何，并且（暂时）包括总直径小于1厘米的浸润癌，如果腋窝淋巴结未受累。许多微小乳腺癌病例是无症状的。如果不采用特殊筛查，不到10%的乳腺癌女性在确诊时处于微小癌阶段。筛查项目可将这一比例提高至多达三分之一的患者，甚至可能更高。虽然关于大规模筛查的成本效益仍存在严重问题，但筛查项目似乎是检测微小乳腺癌的最佳方式。当然，筛查项目应包括详细的病史询问和体格检查。乳腺X线摄影的作用仍存在争议。如果没有乳腺X线摄影，很可能至少50%的所有微小癌会被漏诊。在对辐射风险进行了一段时间的重大担忧之后，现在观点似乎正在改变，许多作者愿意接受这样一个事实，即乳腺X线摄影对年轻女性而言益处大于风险。HIP研究表明，风险/效益比在50岁时变得有利。现在许多权威机构会欣然将乳腺X线摄影纳入40岁及以上女性的筛查。一些作者认为，乳腺X线摄影对所有年龄段的患者而言益处大于风险。这个问题需要进行验证，目前正在进行的几项随机前瞻性临床试验正在做这件事。对乳腺X线摄影风险的合理担忧不应掩盖一个非常重要的事实。（摘要截选至400字）
