Napoli M
Center for Medical Consumers, New York, NY 10012-1090, USA.
J Natl Cancer Inst Monogr. 1997(22):11-3. doi: 10.1093/jncimono/1997.22.11.
In the early 1970s, before there was any scientific evidence to prove mammography's benefit to younger women, the American Cancer Society (ACS) and the National Cancer Institute (NCI) began to promote screening for all women over the age of 35. The ACS's message to the public was--and still is--"breast cancer is curable, if detected early enough." In 1985, mammography equipment companies and other businesses with vested interests in getting women to undergo screening began taking over the "public education" efforts with exaggerated claims, such as "a 91% cure rate." By the time the NCI withdrew its mammography screening recommendation to women in their forties, it was too late. Most women now overestimate their odds of developing breast cancer in their forties and overestimate what mammography can do for them. The recent NIH Consensus Conference Report on mammography screening could have a major impact by explaining that the overwhelming majority of breast cancers are unaffected by early detection, either because they are aggressive or slow growing. Women must be better informed about the risks of mammography screening, especially the uncertainties surrounding a diagnosis of ductal carcinoma in situ.
20世纪70年代初,在尚无科学证据证明乳房X光检查对年轻女性有益之前,美国癌症协会(ACS)和美国国立癌症研究所(NCI)就开始倡导对所有35岁以上的女性进行筛查。美国癌症协会传达给公众的信息过去是——现在仍然是——“乳腺癌如果发现得足够早,是可以治愈的”。1985年,乳房X光检查设备公司以及其他在促使女性接受筛查方面有既得利益的企业开始接手“公众教育”工作,并夸大其词,比如声称“治愈率达91%”。当美国国立癌症研究所撤回针对40多岁女性的乳房X光检查筛查建议时,为时已晚。现在大多数女性高估了自己在40多岁时患乳腺癌的几率,也高估了乳房X光检查对她们的作用。美国国立卫生研究院(NIH)最近关于乳房X光检查筛查的共识会议报告,通过解释绝大多数乳腺癌不受早期发现的影响,要么是因为它们侵袭性强,要么是生长缓慢,可能会产生重大影响。必须让女性更好地了解乳房X光检查筛查的风险,尤其是围绕原位导管癌诊断的不确定性。