Vogel V G, Yeomans A, Higginbotham E
Department of Breast and Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Breast Cancer Res Treat. 1993 Nov;28(2):195-210. doi: 10.1007/BF00666431.
A large number of women in the population are at risk for the development of breast cancer. Methods now exist to accurately assess risk and to provide quantitative estimates of the chance of a woman developing breast cancer in her lifetime. Histologic assessment of premalignant breast pathology aids in the evaluation of risk. The availability of primary chemoprevention clinical trials reduces the number of indications for prophylactic mastectomy. Women at risk for breast cancer and women who have had a malignant lesion at another anatomic site have an increased risk for new cancers at multiple sites. We propose screening strategies based on epidemiologic information about the risks of these diseases and on the predictive value of the available screening tests. The merits and inadequacies of specific management strategies are considered. We review the risks and benefits of estrogen replacement therapy for women at increased risk for breast cancer and consider the ethical implications of both risk assessment and the various interventions.
人群中有大量女性面临患乳腺癌的风险。目前已有方法可准确评估风险，并对女性一生中患乳腺癌的几率进行定量估计。对癌前乳腺病变进行组织学评估有助于风险评估。原发性化学预防临床试验的开展减少了预防性乳房切除术的适应证数量。有乳腺癌风险的女性以及在其他解剖部位有恶性病变的女性发生多部位新发癌症的风险增加。我们基于有关这些疾病风险的流行病学信息以及现有筛查试验的预测价值提出筛查策略。考虑了特定管理策略的优缺点。我们回顾了乳腺癌风险增加的女性使用雌激素替代疗法的风险和益处，并考虑了风险评估及各种干预措施的伦理意义。
