Strax P
Cancer. 1984 Feb 1;53(3 Suppl):665-70. doi: 10.1002/1097-0142(19840201)53:3+<665::aid-cncr2820531312>3.0.co;2-2.
The serious import of breast cancer lies in its potential for metastatic spread, which probably starts early in the course of the disease. Detection of the lesion when immunocompetence can control the metastases leads to long-term survival. This usually involves detection of unsuspected, preclinical disease. This is the important lesson learned from the large screening program of the Health Insurance Plan of New York, where they used palpation and mammography. The substantial reduction in mortality over a matched control group has continued in a 15-year follow-up. Improved mammography techniques at the Guttman Institute, a mass screening project in New York, New York, conducted in cooperation with the American Cancer Society and in the Breast Cancer Detection Demonstration Project, which used the Guttman Institute program as a prototype, have led to substantially improved yield from mammography in screening. Three important factors in mass screening are discussed: (1) benefits versus hazards in mammography, (2) correct age to start screening, and (3) costs of screening.
乳腺癌的严重之处在于其有发生转移扩散的可能性，这种转移可能在疾病进程早期就开始了。在免疫功能能够控制转移时检测到病变可实现长期生存。这通常涉及检测未被怀疑的临床前疾病。这是从纽约健康保险计划的大型筛查项目中学到的重要经验，该项目采用触诊和乳房X线摄影术。在15年的随访中，与匹配对照组相比，死亡率持续大幅降低。纽约古特曼研究所的乳房X线摄影技术得到改进，该研究所与美国癌症协会合作开展了一项大规模筛查项目，并在乳腺癌检测示范项目中以古特曼研究所的项目为原型，这使得乳房X线摄影术在筛查中的检出率大幅提高。文中讨论了大规模筛查中的三个重要因素：（1）乳房X线摄影术的益处与风险，（2）开始筛查的正确年龄，以及（3）筛查成本。
