J R Coll Gen Pract. 1983 Aug;33(253):473-6.
Early detection of breast cancer depends upon a high index of clinical suspicion as screening programmes are not yet generally available in the United Kingdom. The symptoms and signs of operable breast cancer in 1,205 women presenting prospectively and unselected to the surgical clinics of members of the Yorkshire Breast Cancer Group from 1976 to 1981 are reviewed.Seventy-three per cent of the women were postmenopausal. Seventy-six per cent of the patients presented with a discrete lump. Pain as a presenting symptom was rare, but when questioned 33 per cent of the women admitted that the lump was painful. Forty-two per cent of patients had skin tethering or fixation, but only 22 per cent had nipple retraction or displacement. Forty-two per cent of women had lesions which appeared to have well-defined edges. Only 32 per cent of lesions were clinically T0 or T1, the majority (56 per cent) being T2, and 12 per cent were T3.Standard descriptions of symptoms and signs in breast cancer have so far failed to define in what percentage of patients, diagnostic features are present, and have also omitted to emphasize that in a considerable proportion of women classical signs may be absent. Any breast lump in a postmenopausal woman must be considered malignant until proved otherwise and it is wise to pursue an active diagnostic policy in the premenopausal patient, with early referral for a surgical opinion in both cases.
由于在英国尚未普遍开展筛查项目，乳腺癌的早期发现依赖于较高的临床怀疑指数。本文回顾了1976年至1981年期间前瞻性就诊且未经过挑选的1205名女性患者的可手术乳腺癌的症状和体征，这些患者前往约克郡乳腺癌研究小组成员的外科诊所就诊。73%的女性已绝经。76%的患者表现为可触及的肿块。以疼痛作为首发症状较为少见，但在询问时，33%的女性承认肿块有疼痛。42%的患者有皮肤粘连或固定，但仅有22%的患者有乳头回缩或移位。42%的女性的病变似乎边界清晰。临床上仅有32%的病变为T0或T1期，大多数（56%）为T2期，12%为T3期。目前乳腺癌症状和体征的标准描述未能明确有多少比例的患者存在诊断特征，也未强调相当一部分女性可能不存在典型体征。绝经后女性的任何乳腺肿块在未证实为其他情况之前都必须被视为恶性，对于绝经前患者，采取积极的诊断策略并尽早转诊以获得外科意见是明智的。
