Stevenson J M, Bochenek P, Jamrozik K, Parsons R W, Byrne M J
Department of Public Health, University of Western Australia, Australia.
Aust N Z J Surg. 1997 May;67(5):250-5. doi: 10.1111/j.1445-2197.1997.tb01957.x.
A follow-up study was undertaken of all Western Australian women who had a new diagnosis of breast cancer during 1989. The aims were to determine survival, frequency of recurrence and quality of life (QoL) of Western Australian women 5 years after a diagnosis of breast cancer; to determine reasons for choice or rejection of reconstructive surgery in those women treated by mastectomy, and to determine if the choice of lumpectomy or mastectomy affects subsequent QoL.
The vital status as at 1st June 1994 of all 692 women who had a new diagnosis of breast cancer in 1989 was ascertained by electronic linkage to official mortality registrations. A subsample of 215 survivors who had originally been treated by the nine surgeons who had managed 20 or more cases each was sent a reply-paid postal questionnaire asking about follow-up treatment since diagnosis, recurrence of disease, current QoL and attitudes to, and use of, reconstructive surgery.
The overall survival rate at 5 years was 80.8% (85.9% and 78.8% for Stage I and II, respectively). Cumulative mortality was 35% lower among the third of patients treated by the nine most active surgeons (14% vs 22%, P < 0.02), but this may be subject to referral bias. The subsample was representative of all surviving cases except for being an average of 2.7 years younger at diagnosis (mean ages 55.2 and 57.9 years). The response rate of the subsample to the postal questionnaire was 78%. Of women who had had a mastectomy, 40% had considered having a reconstruction, but only nine (11%) had undergone this operation. Median QoL on the Rosser scale (maximum = 1.0) was 0.9. QoL was worse for the 23% of patients with a recurrence of breast cancer. Patients treated by breast-conserving surgery showed a trend toward a better QoL compared with those treated by mastectomy.
At 5 years after the diagnosis of breast cancer, one in five women had died and an estimated one in four of the survivors had recurrent disease. Quality of life in the remaining patients, half of whom had undergone adjuvant treatment, was very good. These are important baseline data against which to judge the impact of mammographic screening.
对1989年新诊断为乳腺癌的所有西澳大利亚州女性进行了一项随访研究。目的是确定西澳大利亚州女性在乳腺癌诊断5年后的生存率、复发频率和生活质量（QoL）；确定接受乳房切除术的女性选择或拒绝重建手术的原因，以及确定保乳手术或乳房切除术的选择是否会影响随后的生活质量。
通过与官方死亡率登记的电子链接，确定了1989年新诊断为乳腺癌的所有692名女性截至1994年6月1日的生命状态。向最初由9位每位管理20例或更多病例的外科医生治疗的215名幸存者的子样本发送了已付回信邮资的邮政问卷，询问自诊断以来的后续治疗、疾病复发、当前生活质量以及对重建手术的态度和使用情况。
5年总生存率为80.8%（I期和II期分别为85.9%和78.8%）。在由9位最活跃的外科医生治疗的三分之一患者中，累积死亡率低35%（14%对22%，P<0.02），但这可能存在转诊偏倚。该子样本代表了所有存活病例，但诊断时平均年轻2.7岁（平均年龄55.2岁和57.9岁）。子样本对邮政问卷的回复率为78%。在接受乳房切除术的女性中，40%考虑过进行重建，但只有9名（11%）接受了该手术。罗斯量表（最大值=1.0）上的生活质量中位数为0.9。23%乳腺癌复发的患者生活质量较差。与接受乳房切除术的患者相比，接受保乳手术治疗的患者生活质量有更好的趋势。
在乳腺癌诊断5年后，五分之一的女性死亡，估计四分之一的幸存者有复发性疾病。其余患者的生活质量非常好，其中一半接受了辅助治疗。这些是判断乳腺钼靶筛查影响的重要基线数据。
