Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., R.B.B.).
David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (J.G.E.).
Ann Intern Med. 2018 Oct 2;169(7):474-484. doi: 10.7326/M18-1822.
Breast cancer will develop in 12% of women during their lifetime and is the second leading cause of cancer death among U.S. women. Mammography is the most commonly used tool to screen for breast cancer. Considerable uncertainty exists regarding the age at which to begin screening and the optimal screening interval. Breast density is a risk factor for breast cancer. In addition, for women with dense breasts, small tumors may be missed on mammography and the sensitivity of screening is diminished. At the time of publication, 35 states had passed laws mandating that breast density be reported in the letters that radiologists send to women with their mammogram results. The mandated language may be challenging for patients to understand, and such reporting may increase worry for women who are told that their risk for breast cancer is higher than average on the basis of breast density alone. The U.S. Preventive Services Task Force and the American College of Radiology (ACR) have each issued guidelines that address breast cancer screening for women with dense breasts. Both organizations found insufficient evidence to recommend for or against magnetic resonance screening, whereas the ACR advises consideration of ultrasonography for supplemental screening. In this Beyond the Guidelines, 2 experts-a radiologist and a general internist-discuss these controversies. In particular, the discussants review the role of supplemental breast cancer screening, including breast ultrasonography or magnetic resonance imaging for women with dense breasts. Finally, the experts offer specific advice for a patient who finds her mammography reports confusing.
乳腺癌将在女性一生中发展 12%，是美国女性癌症死亡的第二大主要原因。乳房 X 线照相术是筛查乳腺癌最常用的工具。关于开始筛查的年龄和最佳筛查间隔存在相当大的不确定性。乳房密度是乳腺癌的一个危险因素。此外，对于乳房致密的女性，小肿瘤可能会在乳房 X 线照相术中漏诊，筛查的敏感性降低。在出版时，35 个州已经通过法律，要求放射科医生在给接受乳房 X 线照相术的女性发送的信件中报告乳房密度。强制性语言可能使患者难以理解，并且这种报告可能会增加那些仅基于乳房密度就被告知其乳腺癌风险高于平均水平的女性的担忧。美国预防服务工作组和美国放射学院 (ACR) 都发布了针对致密乳房女性乳腺癌筛查的指南。这两个组织都发现没有足够的证据支持或反对磁共振筛查，而 ACR 建议考虑超声作为补充筛查。在这个超越指南中，2 位专家——一位放射科医生和一位普通内科医生——讨论了这些争议。特别是，讨论者回顾了补充乳腺癌筛查的作用，包括对致密乳房女性进行乳房超声或磁共振成像。最后，专家为一位发现其乳房 X 线照相术报告令人困惑的患者提供了具体建议。
