Department of Surgery and Breast Health Center, Kaplan Medical Center, Rehovot, Israel.
Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Ann Surg Oncol. 2021 Aug;28(8):4306-4317. doi: 10.1245/s10434-020-09426-1. Epub 2021 Jan 4.
Ever since screening for early breast cancer (BC) diagnosis was shown to decrease mortality from the disease, screening programs have been widely implemented throughout the world. Targeted age groups and schedules vary between countries but the majority use a population-based approach, regardless of personal BC risk. The purpose of this review was to describe current population-based screening practices, point out some of the shortcomings of these practices, describe BC risk factors and risk assessment models, and present ongoing clinical trials of personalized risk-adapted BC screening. Three ongoing, large-scale, randomized controlled clinical trials (WISDOM in the US, MyPEBS in Europe, and TBST in Italy) were identified through a search of the MEDLINE and US National Library of Medicine (ClinicalTrials.gov) databases. In these trials, women either undergo standard or personalized screening. The trials vary in methods of risk stratification and screening modalities, but all aim to examine whether personalized risk-adapted screening can safely replace the current population-based approach and lead to rates of advanced-stage BC at diagnosis comparable with those of current screening regimens. The results of these trials may change current population-based screening practices.
自早期乳腺癌（BC）筛查被证明可以降低该病死亡率以来，筛查计划已在全球范围内广泛实施。目标年龄组和时间表因国家而异，但大多数国家都采用基于人群的方法，而不论个人的 BC 风险如何。本综述旨在描述当前基于人群的筛查实践，指出这些实践的一些缺点，描述 BC 的危险因素和风险评估模型，并介绍正在进行的个性化风险适应 BC 筛查的临床试验。通过对 MEDLINE 和美国国家医学图书馆（ClinicalTrials.gov）数据库的搜索，确定了三项正在进行的大型、随机对照临床试验（美国的 WISDOM、欧洲的 MyPEBS 和意大利的 TBST）。在这些试验中，女性要么接受标准筛查，要么接受个性化筛查。这些试验在风险分层方法和筛查方式上存在差异，但都旨在检验个性化风险适应筛查是否可以安全替代当前的基于人群的方法，并导致诊断时晚期 BC 的发生率与当前筛查方案相当。这些试验的结果可能会改变当前基于人群的筛查实践。
