Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years.

OBJECTIVE: To evaluate the efficacy of annual mammography over and above annual physical examination of the breasts and the teaching of breast self-examination among women aged 50 to 59 on entry. DESIGN: Individually randomized controlled trial. SETTING: Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer. PARTICIPANTS: Women with no history of breast cancer and no mammography in the previous 12 months were randomly assigned to undergo either annual mammography and physical examination (MP group) or annual physical examination only (PO group). The 39,405 women enrolled from January 1980 through March 1985 were followed for a mean of 8.3 years. DATA COLLECTION: Derived from the participants by initial and annual self-administered questionnaires, from the screening examinations, from the patients' physicians, from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base. Expert panels evaluated histologic and death data. MAIN OUTCOME MEASURES: Rates of referral from screening, rates of detection of breast cancer from screening and from community care, nodal status, tumour size and rates of death from all causes and from breast cancer. RESULTS: Over 85% of the women in each group attended the screening sessions after screen 1. The characteristics of the women in the two groups were similar. Compared with the Canadian population the participants were more likely to be married, have fewer children, have more education, be in a professional occupation, smoke less and have been born in North America. The rate of screen-detected breast cancer on first examination was 7.20 per 1000 in the MP group and 3.45 per 1000 in the PO group, more node-positive tumours were found in the MP group than in the PO group. At subsequent screens the detection rates were a little less than half the rates at screen 1. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.28 in the MP group and 1.18 in the PO group. Of the women with invasive breast cancer through to 7 years, 217 in the MP group and 184 in the PO group had no node involvement, 66 and 56 had one to three nodes involved, 32 and 34 had four or more nodes involved, and 55 and 46 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 39 in the PO group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 0.97 (95% confidence interval 0.62 to 1.52). The survival rates were similar in the two groups. Women whose cancer had been detected by mammography alone had the highest survival rate. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography in addition to physical examination of the breasts detected considerably more node-negative, small tumours than screening with physical examination alone, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.     

Breast Cancer Screening Project in Northeast Florida

The American Cancer Society--Duval Unit, in June, 1987, helped organize a community demonstration screening project involving all hospitals and institutions with mammography units in the area. A Northeast Florida Cooperative Breast Cancer Screening Group was formed comprised of physicians and administrators from each institution. A total of 1,200 women agreed to participate in the project and each underwent complete screening including education, instruction in self-examination, physical examination by a physician and mammography as indicated according to ACS guidelines. Of the study group, 1,032 women were eligible for mammography at a participating center, and 628 (61%) underwent a mammogram at no cost to them as instructed. Twenty four (4%) had definite abnormalities which led to biopsy and seven (1%) of them had malignant lesions. The medical community organized to provide breast cancer screening and follow-up with low-cost mammography.     

应用套餐检查对1028例妇女实施乳腺筛查结果分析

目的探讨联合检查在相对健康女性中，对早期乳腺癌及癌前病变筛查的价值。方法在1028例女性健康体检中，应用专业的彩色B超和钼靶x线摄像，配合外科临床检查。结果1028例女性，外科临床检查、彩色B超、钼靶X线有一项为4级以上者有13例；术后病理证实3例为乳腺癌，按TNM分期，2例I期；1例IⅡ期。结论联合检查对发现早期乳腺癌效果显著。     

Age as a factor in breast cancer knowledge, attitudes and screening behaviour.

OBJECTIVE: To determine whether there are age-related differences in knowledge, attitudes and behaviour with respect to breast cancer and whether the differences reflect the age-specific Canadian recommendations on breast cancer screening. DESIGN: Telephone survey. SETTING: Two cities and five towns and their surrounding areas in Alberta. PARTICIPANTS: The age-specific, randomly selected sample comprised 1284 women aged 40 to 75 years who did not have breast cancer. Of the 1741 eligible women who were contacted, 1350 (78%) agreed to participate; 66 were excluded because of age ineligibility or a history of breast cancer. MAIN OUTCOME MEASURE: Frequency of knowledge, attitudes and behaviour with respect to breast cancer, by age group. RESULTS: Knowledge of breast cancer risk factors was generally low and decreased with age. Few women were aware of the Canadian recommendations on breast self-examination, physical examination of the breasts by a health care practitioner and mammographic screening. Older women believed they were less susceptible to breast cancer than younger women and were less likely to have positive attitudes toward screening. Self-examination was performed 9 to 15 times per year by 424 women (33%), and 810 (63%) had been examined by a health care professional in the past year. Although 664 (52%) had undergone mammography, the proportion decreased with age after age 59. The main barriers to mammography were lack of physician referral and the woman's belief that the procedure is unnecessary if she is healthy. CONCLUSIONS: Education is needed to increase breast cancer knowledge, promote the Canadian recommendations for early detection of breast cancer and decrease negative beliefs about the disease. Changes in the behaviour of women and physicians are needed to increase the use of breast self-examination, clinical breast examination by a health care professional and mammographic screening. Reaching women in the upper range (60 to 69 years) of the target group for mammographic screening should be a focus in promoting early detection of breast cancer.     

The value of mammography screening in women under age 50 years

Two quantitative methods, Confidence Profiles and CAN*TROL, are used to analyze evidence and estimate the health and economic consequences of adding annual mammography to annual breast physical examinations in asymptomatic women aged 40 to 49 years who are at average risk for breast cancer. Such women have about a 128 in 10,000 chance of having breast cancer in the next ten years and about an 82 in 10,000 chance of dying of such a cancer. Adding annual mammograms to annual breast physical examinations each year during that age decade would reduce the probability of death to about 60 in 10,000, a reduction of about 26%. Screening would increase the expected lifetime of a woman destined to get breast cancer between ages 40 and 49 years by about 3.5 years. Ten years of screening with mammography in that age decade carries a risk of radiation-induced cancer of about one in 25,000 and a risk of a surgery recommendation for a lesion that is not cancer of about one in ten. If 25% of the women in this age group in the United States were screened every year, breast cancer mortality in the year 2000 would be decreased by about 373 deaths. In 1984 dollars, the cost of screening, workups, and continuing care in the year 2000 would be about $408 million. Treatment costs would be decreased by about $6 million, leaving a net increase in costs in the year 2000 of approximately $402 million (1984 dollars).     

Preventive health care, 1999 update: 3. Follow-up after breast cancer

OBJECTIVE: To make recommendations to physicians who provide follow-up care for women who have been treated for early-stage breast cancer. OPTIONS: Combination of blood tests, bone scans, liver echography and chest radiography for detection of distant disease; physical examination with or without mammography for detection of contralateral breast cancer; and physical examination with or without mammography for detection of ipsilateral recurrent disease after breast-conserving therapy. OUTCOMES: Survival, disease recurrence and quality-of-life measures for distant disease, local recurrence of disease and disease in the contralateral breast. EVIDENCE: A MEDLINE search for relevant articles published between January 1966 and January 1998 with the MeSH terms "breast neoplasms" and "neoplasm recurrence" (local and distant) with limits to "human" was done. A subsequent MEDLINE search using the MeSH terms "breast neoplasms," "neoplasm recurrence," "local/diagnosis" and "mammography" was done to address issues of mammography. The literature search was reviewed by a medical librarian and 2 breast cancer specialists to ensure completeness. BENEFITS, HARMS AND COSTS: Breast cancer is the most common cancer in Canadian women and is the second leading cause of death after lung cancer. Even with early-stage breast cancer, recurrence after treatment for primary breast cancer is frequent. Traditionally, follow-up has been felt to facilitate early detection and improve survival. Randomized controlled trials (RCTs) have shown that routine screening (blood tests and diagnostic imaging) for distant disease does not alter survival or quality of life over routine physical examination. In an underpowered secondary analysis of RCT data, the detection of contralateral breast cancer did not affect survival. However, there have been no RCTs examining the role of mammography and physical examination and their effect on survival in the detection of contralateral breast cancer. The sensitivity and specificity of mammography after local excision and radiotherapy is unknown. There have been no RCTs examining the role of mammography or physical examination, or both, and their effect on survival in the detection of ipsilateral breast recurrence. VALUES: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. A high value was placed on interventions that changed survival. When evidence was available, high value was also placed on interventions that affected quality of life. RECOMMENDATIONS: There is good evidence not to include blood work and diagnostic imaging as part of screening for distant disease (grade E recommendation). There is no evidence to suggest that mammography decreases mortality by detecting ipsilateral disease in the conservatively treated breast; however, there is indirect evidence that it may be beneficial (grade C recommendation). There is no direct evidence to suggest that physical examination or mammography, or both, should be used to detect contralateral breast cancer; however, there is indirect evidence that it may be beneficial (grade C recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care.     

Screening for breast cancer: the role of mammography.

The early diagnosis of breast cancer by screening is a relatively new development in medical practice and its enthusiastic acceptance needs to be tempered by an appraisal of the costs, the risks and the potential benefits. No case can be made at present for screening well women under the age of 50 years, when such screening includes mammography. With the exception of women who have already had cancer in one breast, it is likely that those women under 50 with the associated "risk factors" are better managed by careful attention to breast self-examination and more frequent physical examinations. Provided that the radiation dose is less than one rad per examination, the benefits to women over 50 outweigh the risks of radiation-induced breast cancer. Against this must be placed the very large cost to the community of screening programmes and the relatively low additional benefits gained by incorporation of mammography into the screening process.     

社会经济地位对安徽省成年女性乳腺癌筛查行为的影响

目的了解安徽省成年女性乳腺癌筛查行为现状及社会经济地位对女性乳腺癌筛查行为的影响。方法采取滚雪球抽样及方便抽样法,对安徽省1 897名18~70岁女性进行网络问卷调查。选取受教育水平、家庭年收入、职业类型综合衡量社会经济地位。采用主成分分析构建社会经济地位综合得分。结果安徽省成年女性的乳腺自我检查率、临床检查率和钼靶检查率分别为19.87%,13.65%和3.74%。安徽省成年女性的乳腺自我检查及乳腺临床检查均与受教育水平、家庭年收入、职业类型及社会经济地位综合得分呈正相关(P<0.01),而乳腺钼靶检查仅与教育水平、职业类型及社会经济地位综合得分呈正相关(P<0.05)。随社会经济地位的增高,安徽省成年女性的乳腺自我检查、临床检查及钼靶检查行为均显著增加(P<0.01)。社会经济地位中、高等女性实施乳腺自我检查的概率分别是社会经济地位低等女性的2.199、3.396倍,进行乳腺临床检查的概率分别是社会经济地位低等女性的1.994、2.921倍,进行乳腺钼靶检查的概率分别是社会经济地位低等女性的1.988、2.345倍。结论安徽省成年女性的乳腺癌筛查行为存在明显的社会经济地位差异,社会经济地位较低的女性是未来乳腺癌防控的重点人群。     

Sensitivity of mammography and physical examination of the breast for detecting breast cancer.

Mammography and physical examination of the breast are evaluated as screening instruments for detecting breast cancer based on local biopsy data obtained from women enrolled in a national breast cancer screening program. One hundren thirteen cancers (15.5%) of women who underwent biopsy) were detected. The individual sensitivities of mammography and physical examination for detecting breast cancer are 62% and 24%, respectively. The sensitivity of the two methods combined is 75% (85 of 113). Thirty-seven cancers were in situ or minimally invasive (less than or equal to 1 cm in greatest dimension). Eighty-one percent (30 of 37) of these small cancers were detected by screening, and they comprised 35% (30 of 85) of all cancers detected by mammography, physical examination, or both. Improved survival is anticipated due to this high rate of discovery of small cancers.     

外科检查、钼靶X线、高频超声联合应用对乳腺癌诊断的评价

目的:探讨外科检查、钼靶X线、高频彩超3者联合检查对乳腺癌早期诊断的价值。方法:选择2007年4月～2009年3月我院收治的年龄30～70岁女性乳腺癌患者共306例。采用外科检查、钼靶X线、高频彩超及3者联合的方法对306例患者进行术前检查,将结果与术后病理对照,比较4种检查方法诊断率的差异,并按照患者年龄、肿瘤大小分层讨论其意义。结果:外科检查、钼靶X线、高频彩超及三者联合的诊断率分别是68.6%,69.9%,80.7%,98.0%;结论:外科检查、钼靶X线、高频彩超三者联合检查能明显提高早期乳腺癌的诊断率。     

番禺区35～70岁部分妇女乳腺癌普查结果分析

目的：通过对番禺区部分妇女乳腺癌普查情况分析,了解区内乳腺癌的发病情况。方法：2007—2009年对番禺区10012名35～70岁妇女进行乳腺检查,询问生活史、乳腺临床触诊,结合钼靶及彩色B超检查,对有肿块者作病理活检确诊。结果：在本次普查中35～70岁妇女乳腺癌患病率0．699％o（7／10012）,50～59岁组为本地区乳腺癌高发年龄阶段,发病率为1．02％o（2／1965）。结论：番禺区妇女乳腺癌发病率较高,值得大家引起重视,应加强宣传,建立早期普查的正确观念。     

查体、超声及钼靶检查对乳腺癌新辅助化疗后病理缓解程度预测价值的比较

目的：通过对查体、超声和钼靶片测量化疗前后乳腺肿物大小的变化与术后病理Miller and Payne (MP)分级的比较,探讨预测新辅助化疗(NAC)后病灶病理缓解程度的方法。方法：选择本科室乳腺癌NAC并手术的患者65例,采用麦默通(14G)行穿刺活检,病理诊断明确后行1～6个疗程TAC方案（多西他赛、多柔比星和环...     

2016~2020年北京某地区5879名女性乳腺癌筛查结果分析

目的 探讨近年来适龄健康女性乳腺疾病的发病情况、影响因素及适合我国国情的乳腺癌筛查方法。方法 选择2016～2020年北京某地区5879名女性作为筛查对象,外科临床检查配合专业的彩色B超和乳腺钼靶,并对筛查结果进行统计学分析。结果 5879名女性中,47.28%的女性患有各种乳腺疾病,术后病理证实5例乳腺癌,检出率0.085%。月经初潮时间早、绝经时间晚、乳腺癌家族史等高危因素均会增加乳腺疾病的发病率,且乳腺癌的发病趋于年轻化。结论 针对个体的不同,给予不同的筛查手段,可大规模节约人员和经济成本,使我国适龄女性能更好地从乳腺癌筛查中获益。     

CT、超声、X线钼靶在乳腺癌诊断中的应用价值研究

目的探究超声、X线钼靶及CT在乳腺癌诊断中的应用价值。方法选取我院2011年5月至2014年5月60例乳腺癌患者作为研究对象,按照诊断方法的不同将其分为超声组、X线钼靶组、CT组、超声联合X线钼靶及CT组（联合组）,观察各组患者阳性检出率。结果超声检查、X线钼靶检查、CT检查三组两两阳性检出率比较,p〉0.05,差异无统计学意义;联合检查组分别与CT检查、超声检查、X线钼靶检查阳性检出率比较,p〈0.05,差异具有统计学意义;四组组患者病理情况比较,p〉0.05,差异无统计学意义。结论超声检查和X线钼靶检查、CT检查各有优势,三者联合可提高乳腺癌的检出率,有利于早期诊断发现。     

Screening Mammography Program of British Columbia: pattern of use and health care system costs

BACKGROUND: The use of mammography for screening asymptomatic women has increased dramatically in the past decade. This report describes the changes that have occurred in the use of bilateral mammography in British Columbia since the provincial breast cancer screening program began in 1988. METHODS: Using province-wide databases from both the breast cancer screening program and the provincial health insurance plan in BC, the authors determined the number and costs of bilateral mammography services for women aged 40 years or older between Apr. 1, 1986, and Mar. 31, 1997. Unilateral mammography was excluded because it is used for investigating symptomatic disease and screening abnormalities, and for follow-up of women who have undergone mastectomy for cancer. RESULTS: As the provincial breast cancer screening program expanded from 1 site in 1988 to 23 in 1997, it provided an increasing proportion of the bilateral mammographic examinations carried out each year in BC. In fiscal year 1996/97, 65% of bilateral mammographic examinations were performed through the screening program. The cost per examination within the screening program dropped as volume increased. Thirty percent more bilateral mammography examinations were done in 1996/97 than in 1991/92, but health care system expenditures for these services increased by only 4% during the same period. In calendar year 1996, 21% of new breast cancers were diagnosed as a result of a screening program visit. INTERPRETATION: Substantial increases in health care expenditures have been avoided by shifting bilateral mammography services to the provincial screening program, which has a lower cost per screening visit.     

Cancer screening for the primary care physician

Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He (she) is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen (PSA) and digital rectal examination screening for prostate cancer are still controversial.     

保定市妇女乳腺疾病的调查分析

目的了解妇女乳腺常见疾病的发病情况,探讨影响乳腺疾病发病率及乳腺癌病死率的因素。方法选取2010年1月至2013年2月在河北大学附属医院进行体检的6769例妇女,采用手诊结合IBS800红外乳腺检查仪(台车式)进行乳房透照,可疑乳腺病变者进一步行乳腺B超、乳腺钼靶X线摄片及乳腺核磁共振检查,以确诊乳腺增生病、乳腺良性肿瘤或乳腺癌。结果患乳腺疾病人数为4370例,患病率为64.56%;乳腺增生病人数为3827例,发病率为56.54%,发病率居乳腺疾病的首位,多发于30⁴9岁;副乳腺229例,发病率为3.38%,仅次于乳腺增生病;乳腺癌19例,发病率281/10万。结论乳腺增生病是妇女乳腺疾病中最常见的疾病,倡导妇女定期到专业医疗单位体检,早发现,早诊断,早治疗乳腺疾病,通过体检筛查降低乳腺癌的病死率,提高妇女生活质量和健康水平。     

Breast examination of older women in a teaching hospital.

INTRODUCTION: Breast examination during routine physical examination may help detect breast cancer and effect early treatment. OBJECTIVE: To determine whether doctors routinely perform breast examination in older women, and to assess attitudes of patients and doctors to this examination. METHODS: A questionnaire based survey of 150 women over 65 years attending a teaching hospital, and 51 doctors working in this hospital. RESULTS: Very few women had a breast examination performed by a doctor. All thought breast examination was important, and would give consent for this examination. Although the great majority of doctors thought breast examination should be done routinely only very few do so. CONCLUSION: Older women have a positive attitude towards breast examination, but this is not reflected by the practice of doctors. There is a need for change in attitudes and training among doctors so that breast examination would be performed routinely.     

Comparative study of mammography and mammary serum antigen estimation for breast cancer screening.

OBJECTIVE: To compare mammary serum antigen (MSA) levels with mammography as a screening test for breast cancer. To determine the value of MSA testing to decrease the need for women to undergo mammography. DESIGN: A blind prospective comparison of MSA levels and mammography to detect breast cancer. SETTING: Royal Women's Hospital Breast Cancer Screening Clinic. Women were mainly self-referred. RESULTS: MSA levels had a wide range in normal women and women with mammography-detected breast cancer. Mean MSA levels in women with breast cancer reflected tumour volume, but a wide range was again seen. At 60% specificity, the sensitivity of an elevated MSA level for breast cancer was 63% for invasive cancer and zero for in-situ disease. MSA levels were modestly but significantly elevated in smokers over non-smokers. CONCLUSION: The MSA level is an insufficiently sensitive or specific marker to have a role in screening for breast cancer.