Chamberlain J, Rogers P, Price J L, Ginks S, Nathan B E, Burn I
Lancet. 1975 Nov 22;2(7943):1026-30. doi: 10.1016/s0140-6736(75)90304-9.
This study is aiming to determine the validity and observer variability of clinical examination and mammography as screening tests for breast cancer. Women over the age of forty are given two independent clinical examinations of the breasts, and mammograms are taken and read independently by two radiologists. This paper presents the results of screening the first 1215 women to be enrolled in the study. At their first screening attendance, 231 women (19%) were referred for surgical opinion, 119 (9-8%) underwent biopsy, and cancer was diagnosed in 17 (1-4%). 2 further cancers were diagnosed in the ensuing six months among women who had been negative on initial screening, representing a false-negative rate of 2 out of 19 (11%). Clinical examination resulted in 189 referrals (15-6%), 90 biopsies (7-4%), and detected 11 cancers; corresponding figures for mammography were 76 referrals (6-3%), 55 biopsies ((4-5%), and 14 cancers. Observer variability was greater for clinical examination than for mammography. These early results suggest that as a screening test mammography compares favourably with clinical examination, but both tests are necessary if many false negatives are to be avoided.
本研究旨在确定临床检查和乳房X线摄影作为乳腺癌筛查测试的有效性及观察者变异性。对40岁以上的女性进行两次独立的乳房临床检查，并由两名放射科医生分别进行乳房X线摄影并解读结果。本文呈现了对该研究纳入的首批1215名女性进行筛查的结果。在她们首次参加筛查时，231名女性（19%）被转诊以征求手术意见，119名（9.8%）接受了活检，确诊癌症的有17名（1.4%）。在最初筛查为阴性的女性中，随后的六个月内又诊断出2例癌症，假阴性率为19例中有2例（11%）。临床检查导致189名女性被转诊（15.6%），90名接受活检（7.4%），并检测出11例癌症；乳房X线摄影的相应数字分别为76名被转诊（6.3%），55名接受活检（4.5%），以及14例癌症。临床检查的观察者变异性大于乳房X线摄影。这些早期结果表明，作为一种筛查测试，乳房X线摄影优于临床检查，但如果要避免许多假阴性情况，两种测试都是必要的。
