King S E, Schottenfeld D
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA.
Oncology (Williston Park). 1996 Apr;10(4):453-62; discussion 462, 464, 470-2.
Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I breast cancers have been increasing, while the incidence of later-stage cancers has been decreasing. Increased mammography screening may explain the documented jump in breast cancer incidence rates during the mid-1980s. Differences in the distribution of breast cancer risk factors may account, in part, for the temporal trends in breast cancer incidence. In particular, breast cancer risk factors may vary by birth cohort, including age at menarche, age at first birth, physical activity, obesity, diet, alcohol intake, estrogen therapy, and exposure to environmental organochlorines. After decades of epidemiologic research, a preventive approach to breast cancer that focuses on the physiologic effects of the sex steroid hormones, and their potential interactions with family history, is being carefully formulated.
1973年至1991年间，美国乳腺癌发病率上升了24%。然而，在此期间死亡率保持稳定。5年相对生存率以及原位癌和I期乳腺癌的发病率一直在上升，而晚期癌症的发病率则在下降。乳腺钼靶筛查的增加可能解释了20世纪80年代中期记录的乳腺癌发病率的跃升。乳腺癌风险因素分布的差异可能在一定程度上解释了乳腺癌发病率的时间趋势。特别是，乳腺癌风险因素可能因出生队列而异，包括初潮年龄、首次生育年龄、身体活动、肥胖、饮食、酒精摄入、雌激素治疗以及接触环境有机氯。经过数十年的流行病学研究，一种针对乳腺癌的预防方法正在精心制定中，该方法侧重于性甾体激素的生理作用及其与家族史的潜在相互作用。
