Tabár L, Dean P B
Radiol Clin North Am. 1987 Sep;25(5):993-1005.
There are few forms of cancer that can be effectively controlled. Now that there is sufficient evidence demonstrating that mortality from breast cancer can be reduced with the help of mammography screening, we are faced with the challenge of applying this method on a large scale. What are the major practical problems? The medical profession and decision makers must be made familiar with nature of the recent achievements and with their practical implications. The personnel who will be responsible for undertaking screening have to be adequately trained before screening gets under way. Women should understand the benefits that they can gain from mammography screening so that they will be sufficiently motivated to attend. This can be achieved by sincere, periodic information through the mass media. It is important that every woman eligible for screening understand that her risk of dying from breast cancer will be half as much if she participates in screening as it would be if she fails to participate. She should also be aware that the smaller cancers detected at screening can often be removed by breast conserving surgery without the need for mastectomy. Because mammography does not prevent breast cancer, women must be aware of the fact that mammography has to be repeated at regular intervals if the benefits of screening are to be maintained. Additionally, breast self-examination should be practiced in the interval between screens. Finally, decision makers will have to realize that screening with mammography can, in the long run, lead to reduction of health service costs. It is obvious that the expenses involved in taking care of a patient with advanced breast carcinoma can be very high. As it has been clearly demonstrated that properly performed screening will significantly decrease the number of advanced, costly breast carcinomas, a large proportion of these expenses will be saved in the population invited to screening. Because screening itself drains economic resources, the costs of screening outweigh the savings until the number of advanced cancers decreases; however, after this occurs the expenses of screening will be far less than the savings. The savings arise from the smaller number of advanced, costly cases. The results to date are convincing enough to justify recommending large-scale mammographic screening. The Swedish government has recommended screening with mammography for all women aged 40-74. This recommendation repeatedly emphasizes the necessity of high quality examinations interpreted by well-trained radiologists.
几乎没有几种癌症能够得到有效控制。既然有充分证据表明，乳房X光检查筛查有助于降低乳腺癌死亡率，那么我们就面临着大规模应用这一方法的挑战。主要的实际问题有哪些呢？必须让医学专业人士和决策者熟悉近期成果的性质及其实际影响。在筛查开始之前，负责进行筛查的人员必须接受充分培训。女性应该了解她们能够从乳房X光检查筛查中获得的益处，这样她们才会有足够的积极性去参加。这可以通过大众媒体定期提供真诚的信息来实现。重要的是，每个符合筛查条件的女性都要明白，如果她参加筛查，死于乳腺癌的风险将是不参加筛查的一半。她还应该意识到，筛查时发现的较小癌症通常可以通过保乳手术切除，而无需进行乳房切除术。由于乳房X光检查并不能预防乳腺癌，女性必须意识到，如果要保持筛查的益处，就必须定期重复进行乳房X光检查。此外，在两次筛查之间应进行乳房自我检查。最后，决策者必须认识到，从长远来看，乳房X光检查筛查能够降低医疗服务成本。显然，照顾一名晚期乳腺癌患者的费用可能非常高。正如已经清楚表明的那样，正确进行的筛查将显著减少晚期、昂贵的乳腺癌病例数量，在受邀参加筛查的人群中，很大一部分此类费用将得以节省。由于筛查本身会消耗经济资源，在晚期癌症数量减少之前筛查成本超过节省的费用；然而，在这种情况发生之后，筛查费用将远低于节省的费用。节省的费用来自数量较少的晚期、昂贵病例。迄今为止的结果足以令人信服，证明推荐大规模乳房X光检查筛查是合理的。瑞典政府已建议对所有40至74岁的女性进行乳房X光检查筛查。这一建议反复强调由训练有素的放射科医生进行高质量检查的必要性。
