Rodes N D, Blackwell C W, Farrell C
Major Probl Clin Surg. 1979;5:91-112.
Screening is a more complicated issue than has been indicated in this chapter. Long-term followup is essential to exclude misleading initial impressions, and survival predictions must stand this test. The problem of interval cancers must be acknowledged, and methods of developing more cost-effective systems that might provide even broader coverage of the population at risk have to be considered. Suffice it to say that mass screening for breast cancer can be accomplished. Large numbers of American women are sufficiently concerned about this disease to participate, as evidenced by the success of the National Cancer Institute/American Cancer Society Breast Cancer Detection Demonstration Projects. It has been demonstrated that breast cancers so small that they would previously be considered a pathological curiosity are detected with surprising frequency. The ultimate effect on survival time by this screening can of course only be determined after passage of time, but there is every reason to believe that it represents one of the really great advances in detection-diagnosis in recent history. The chief detection modality is mammography, and it is to be expected that technological advances in this area will permit images of even greater reliability and resolution at a level of radiation exposure that will be acceptable to everyone. The definitive role of thermography in detection of breast disease has yet to be fully determined. The maximal scientific benefit and the true impact of the screening demonstration projects will be realized only after long-term followup of the 280,000 participants.
筛查是一个比本章所指出的更为复杂的问题。长期随访对于排除误导性的初始印象至关重要，生存预测必须经得起这种检验。必须认识到间期癌的问题，并且必须考虑开发更具成本效益的系统的方法，这些系统可能会为更多的高危人群提供更广泛的覆盖。可以说，乳腺癌的大规模筛查是可以实现的。大量美国女性对这种疾病非常关注并愿意参与，美国国家癌症研究所/美国癌症协会乳腺癌检测示范项目的成功就是证明。已经证明，那些以前会被视为病理上罕见情况的非常小的乳腺癌被检测到的频率令人惊讶。这种筛查对生存时间的最终影响当然只有在经过一段时间后才能确定，但有充分理由相信，它代表了近代检测诊断方面真正的重大进展之一。主要的检测方式是乳房X线摄影，预计该领域的技术进步将在每个人都能接受的辐射剂量水平上提供可靠性和分辨率更高的图像。热成像在乳腺疾病检测中的决定性作用尚未完全确定。只有在对28万名参与者进行长期随访之后，筛查示范项目的最大科学益处和真正影响才能实现。
