Solin L J, Legorreta A, Schultz D J, Zatz S, Goodman R L
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.
Arch Intern Med. 1994 Apr 11;154(7):745-52.
The use of mammographic screening for the early detection of breast cancer has been shown to reduce the mortality from breast cancer. However, the impact of mammographic screening relative to the local treatment of the breast (ie, breast-conservation treatment vs mastectomy) is not well established.
An analysis was performed of 206 newly diagnosed and treated breast cancers in 201 women identified in 1989 from a health maintenance organization (US Healthcare, Blue Bell, Pa). The 206 breast cancers were evaluated for eligibility for and actual local treatment of the breast with breast-conserving surgery and definitive breast irradiation as a function of mammographic screening for the early detection of breast cancer.
Eligibility for local treatment of the breast with breast-conserving surgery and definitive breast irradiation was significantly increased for the breast cancers detected in women who had undergone mammographic screening compared with the breast cancers detected in women who had not undergone mammographic screening (88% vs 60%, respectively; P < .0001). For the breast cancers that were eligible on chart review for treatment with breast-conserving surgery and definitive breast irradiation, there was no significant difference in the actual local treatment of the breast with breast-conserving surgery and definitive breast irradiation for the eligible breast cancers detected in women who had undergone mammographic screening compared with the eligible breast cancers detected in women who had not undergone mammographic screening (44% vs 37%, respectively; P = .40); however, there was a statistically significant difference for the subgroup of women aged 50 years or more (49% vs 21%, respectively; P = .016).
These results show that breast cancers detected in women who had undergone mammographic screening were more likely to be eligible for breast-conserving surgery and definitive breast irradiation compared with breast cancers detected in women who had not undergone mammographic screening. For women aged 50 years or more, there was a significant increase in the use of breast-conserving surgery and definitive breast irradiation for eligible breast cancers detected in women who had undergone mammographic screening compared with eligible breast cancers detected in women who had not undergone mammographic screening.
乳腺钼靶筛查用于早期发现乳腺癌已被证明可降低乳腺癌死亡率。然而，乳腺钼靶筛查相对于乳腺局部治疗（即保乳治疗与乳房切除术）的影响尚未明确。
对1989年从一家健康维护组织（美国医疗保健公司，宾夕法尼亚州蓝铃市）确诊并接受治疗的201名女性中的206例新发乳腺癌进行了分析。根据用于早期发现乳腺癌的乳腺钼靶筛查情况，对这206例乳腺癌进行评估，以确定其是否适合并实际接受了保乳手术及根治性乳腺放疗等乳腺局部治疗。
与未接受乳腺钼靶筛查的女性所患乳腺癌相比，接受乳腺钼靶筛查的女性所患乳腺癌接受保乳手术及根治性乳腺放疗等乳腺局部治疗的可能性显著增加（分别为88%和60%；P <.0001）。对于经病历审查适合保乳手术及根治性乳腺放疗的乳腺癌，接受乳腺钼靶筛查的女性所患符合条件的乳腺癌实际接受保乳手术及根治性乳腺放疗的比例与未接受乳腺钼靶筛查的女性所患符合条件的乳腺癌相比，无显著差异（分别为44%和37%；P =.40）；然而，对于年龄在50岁及以上的女性亚组，存在统计学显著差异（分别为49%和21%；P =.016）。
这些结果表明，与未接受乳腺钼靶筛查的女性所患乳腺癌相比，接受乳腺钼靶筛查的女性所患乳腺癌更有可能适合保乳手术及根治性乳腺放疗。对于年龄在50岁及以上的女性，与未接受乳腺钼靶筛查的女性所患符合条件的乳腺癌相比，接受乳腺钼靶筛查的女性所患符合条件的乳腺癌接受保乳手术及根治性乳腺放疗的比例显著增加。
