Esserman L, Kerlikowske K
Department of Surgery, University of California, San Francisco, USA.
Oncology (Williston Park). 1996 Mar;10(3):357-64; discussion: 370-6.
In clinical trials, screening mammography has been shown to reduce mortality from breast cancer by about 25% to 30% among women aged 50 years and older after only 5 to 6 years from the initiation of screening. Among women 40 to 49 years old, the evidence supporting the efficacy of screening mammography is less convincing. Eight randomized controlled trials have reported no statistically significant reduction in breast cancer mortality among women age 40 to 49 years after 7 to 9 years from the initiation of screening. After 10 to 12 years from the initiation of screening, there is a trend toward a reduction in breast cancer mortality that appears to be smaller than that observed in women age 50 and older. Even if there is a small delayed reduction in breast cancer mortality among women age 40 to 49 years, the potential absolute benefit of screening women in this age group is likely to be small, given that the incidence of breast cancer is low. Since there is strong scientific evidence that mammography reduces breast cancer mortality among women age 50 and older, our national focus should be on screening these women who have the most to benefit.
在临床试验中，乳腺钼靶筛查已显示出，在50岁及以上的女性中，从开始筛查仅5至6年后，乳腺癌死亡率可降低约25%至30%。在40至49岁的女性中，支持乳腺钼靶筛查有效性的证据不那么令人信服。八项随机对照试验报告称，在40至49岁的女性中，从开始筛查7至9年后，乳腺癌死亡率没有统计学上的显著降低。在开始筛查10至12年后，乳腺癌死亡率有下降趋势，但似乎比50岁及以上女性中观察到的降幅小。即使40至49岁的女性乳腺癌死亡率有轻微的延迟下降，鉴于该年龄组乳腺癌发病率较低，对这一年龄组女性进行筛查的潜在绝对益处可能也很小。由于有强有力的科学证据表明乳腺钼靶筛查可降低50岁及以上女性的乳腺癌死亡率，我们国家的重点应放在筛查这些最能受益的女性身上。
