Campbell I, Royle G, Coddington R, Herbert A, Rubin C, Taylor I, Guyer P
Breast Screening Unit, Royal South Hants Hospital, Southhampton.
Ann R Coll Surg Engl. 1993 Jan;75(1):13-7.
With the natural history and optimal treatment of a high proportion of screen-detected breast cancers yet to be determined, treatment poses the management team with a number of therapeutic dilemmas. This study surveys the management policy and treatment of a consecutive series of 100 screen-detected cancers treated in a single breast unit. The problems encountered are discussed. There were 87 women with stage Tis or T1 tumours, including 26 women with in situ cancers, four with invasive cancers less than 5 mm in size, and seven with tubular cancers. Sixty-six women were managed with breast-conserving surgery and 36 women underwent localisation biopsy as the sole surgical treatment of the breast. With selection bias for high-grade and lateral tumours, only 2/13 cancers up to 10 mm in size were lymph node positive on axillary clearance. All lymph node positive women received adjuvant therapy. No adjuvant therapy was given in 43 cases, including those with in situ cancer. Thirty-six had extensive intraductal component (EIC). Patient and surgeon choice tends to be a major factor both in type of surgery and adjuvant therapy for screen-detected breast cancer. The optimal treatment for tumours detected by breast cancer screening is debatable and randomised trials on their management need to be expedited.
由于大部分筛查发现的乳腺癌的自然病史和最佳治疗方法尚未确定，治疗给管理团队带来了一些治疗难题。本研究调查了在一个乳腺科连续治疗的100例筛查发现的癌症的管理政策和治疗情况。讨论了所遇到的问题。有87例患有Tis期或T1期肿瘤的女性，其中包括26例原位癌女性、4例浸润性癌大小小于5毫米的女性以及7例管状癌女性。66例女性接受了保乳手术，36例女性接受了定位活检作为乳腺的唯一手术治疗。由于对高级别和外侧肿瘤存在选择偏倚，在腋窝清扫中，仅2/13例大小达10毫米的癌症出现淋巴结阳性。所有淋巴结阳性的女性均接受了辅助治疗。43例患者未接受辅助治疗，包括原位癌患者。36例有广泛导管内成分（EIC）。在筛查发现的乳腺癌的手术类型和辅助治疗方面，患者和外科医生的选择往往是一个主要因素。乳腺癌筛查发现的肿瘤的最佳治疗方法存在争议，需要加快对其管理的随机试验。
