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解决全球乳腺钼靶筛查差距以改善乳腺癌检测:文献综述

Addressing Global Gaps in Mammography Screening for Improved Breast Cancer Detection: A Review of the Literature.

作者信息

Naik Shreya, Varghese Albert P, Asrar Ul Haq Andrabi Syed, Tivaskar Suhas, Luharia Anurag, Mishra Gaurav V

机构信息

Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2024 Aug 5;16(8):e66198. doi: 10.7759/cureus.66198. eCollection 2024 Aug.

Abstract

Breast cancer is the second most common cancer globally, with 2.3 million new cases annually, constituting 11.6% of all cancer cases. It is also the fourth leading cause of cancer deaths, claiming 670,000 lives a year. This high incidence of breast cancer morbidity worldwide has increased the urgent need for standardized and adequate screening methods, including clinical breast examination, self-breast examination, and mammography screening tests for non-symptomatic individuals. Mammography is considered the gold standard for breast cancer screening, with early randomized control trials showing significant reductions in mortality rates in women aged 50 and over (International Agency for Research on Cancer and American College of Radiology). Despite this, discrepancies in mammography practices across different healthcare settings regarding adherence to international standards raise concerns. A comprehensive review of the vast literature looking at the practices and norms of mammography screening worldwide highlighted several domains that present limitations to screening. These include epidemiological data deficits, lack of educational training offered to radiographers and varied image quality indices, exposure technique, method of breast compression, dose calculation, reference levels, screening frequency intervals, and diverse distribution of resources, particularly in developing countries. These factors shed light on the substantial discrepancies in the implementation and efficacy of screening programs, underscoring the necessity for future research endeavors to collaborate in creating coherent, standardized, evidence-based guidelines. Addressing these issues can enhance the feasibility, sensitivity, and accessibility of screening programs, resulting in favorable impacts on the early diagnosis and survival of breast cancer on a global scale.

摘要

乳腺癌是全球第二大常见癌症,每年有230万新发病例,占所有癌症病例的11.6%。它也是癌症死亡的第四大主要原因,每年导致67万人死亡。全球乳腺癌发病率如此之高,使得对标准化且充分的筛查方法的需求更加迫切,这些方法包括临床乳腺检查、自我乳腺检查以及针对无症状个体的乳房X线摄影筛查测试。乳房X线摄影被认为是乳腺癌筛查的金标准,早期随机对照试验表明,50岁及以上女性的死亡率显著降低(国际癌症研究机构和美国放射学会)。尽管如此,不同医疗机构在乳房X线摄影实践中对国际标准的遵守情况存在差异,这引发了人们的担忧。一项对全球乳房X线摄影筛查实践和规范的大量文献进行的全面综述突出了几个对筛查存在限制的领域。这些领域包括流行病学数据不足、放射技师缺乏教育培训、图像质量指标各异、曝光技术、乳房压迫方法、剂量计算、参考水平、筛查频率间隔以及资源分配不均,尤其是在发展中国家。这些因素揭示了筛查项目在实施和效果方面存在的巨大差异,强调了未来研究合作制定连贯、标准化、循证指南的必要性。解决这些问题可以提高筛查项目的可行性、敏感性和可及性,从而对全球乳腺癌的早期诊断和生存率产生积极影响。

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本文引用的文献

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Quality assurance in Mammography: An overview.乳腺 X 线摄影中的质量保证:概述。
Eur J Radiol. 2023 Aug;165:110935. doi: 10.1016/j.ejrad.2023.110935. Epub 2023 Jun 19.

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