肝癌高危人群监查的研究进展

筛检和监查高危人群是发现早期肝癌的主要措施。对乙型，丙型肝炎病毒感染，肝硬化等肝癌高危人群，每6个月监查一次B超和（或）血清AFP。早期发现的肝癌患者经有效治疗后，生存期延长，生存率提高。     

肝癌高危人群监查的研究进展

山东大学齐鲁医院消化内科，山东 济南 250012筛检和监查高危人群是发现早期肝癌的主要措施。对乙型、丙型肝炎病毒感染、肝硬化等肝癌高危人群，每6个月监查一次B超和(或)血清AFP。早期发现的肝癌患者经有效治疗后，生存期延长，生存率提高。     

美国癌症协会推荐对乳腺癌高危人群作核磁筛查

磁共振成像,多写成MRI,过去也叫过核磁共振,是高科技的检查项目,是一项昂贵的检查。美国癌症协会在新版的《乳腺癌筛查指南》中增加了一项新内容,即对有些发生乳腺癌的高危险妇女,要在筛查时联合乳腺照相作MRI扫描,不是代替乳腺照相。     

高危人群中肺癌筛查方法的研究进展

肺癌是世界范围内最常见的恶性肿瘤之一。在高危人群中开展肺癌的早期筛查,被认为对改善肺癌预后是非常有益的。本文就在高危人群中进行早期筛查的方法进行综述。     

乳腺癌高危因素

0 引言 乳腺癌已经成为严重威胁女性健康的恶性肿瘤,在西方发达国家发病率较发展中国家高.但随着经济水平不断提高,发展中国家乳腺癌发病率逐年上升,越来越接近欧美等国家.文献报道[1],北京城区1982-2001年间,女性乳腺癌发病率呈逐年上升趋势,平均每年递增4.6%;35～64岁截缩发病率高达95.3/10万.     

原发性肝癌高危人群的研究

本文通过分析上海市肝癌发病情况和上海医科大学肝癌研究所的肝癌住院病人，显示上海市肝癌男性标化发病率为２９．６／１０万，女性为１０．０／１０万，男女合计为２０．１／１０万。男女发病率比约为３：１．男性肝癌发病率在３５岁前较低。以后逐渐上升，至４０岁接近男性全市平均水平，５０岁后发病率增幅较前要快，至８０岁达到高峰。女性肝癌发病率较男性低，年龄亦较晚，到５０岁才接近女性全市平均水平，发病年龄的高峰与男性相差１０年左右。肝癌患者中ＨＢｓＡｇ的阳性率显著高于自然人群，在有慢性肝炎史的肝癌患者中有近１／４的人ＨＢｓＡｇ阴性，提示有丙肝病毒感染的可能，肝癌患者的抗－ＨＣＶ阳性率为１１．１％，与ＨＢｓＡｇ的双重阳性率为５．８％，提示与ＨＢｓＡｇ独立，而在人群中抗ＨＣＶ的阳性率为２％左右，提示ＨＣＶ也是原发性肝癌的危险因素，所以肝癌的高危人群应包括抗ＨＣＶ阳性及一切有慢性病毒性肝炎史者。本文认为，在上海市，男性４５岁以上，女性５０岁以上，ＨＢｓＡｇ阳性或抗ＨＣＶ阳性或有慢性肝炎史的人群是肝癌的高危人群。     

河南新乡地区女性乳腺癌危险因素的病例对照研究

目的 调查新乡地区女性乳腺癌危险因素，为确定高危人群、提出预防措施提供依据。方法 我们从1992年4月到1997年4月与中国医科院肿瘤医院合作开展了《中国大样本乳腺癌病例对照调查研究》，这5年中对我院就诊的经我院病理证实的乳腺癌300例进行病例对照研究。研究其妇科史、药物史、吸烟史及饮食史、家族史、疾病史、染发史等。结果 在单因素分析中，达到显著性水平的危险因素为行经期≥35年、服用避孕药、良性乳腺疾病史、被动吸烟及常食用蜂王浆等，达到显著性水平的保护因素为哺乳及常食豆类食品。条件(1ogistic)多元回归分析显示：重要的有统计学显著意义的乳腺癌危险因素是良性乳腺疾病史、被动吸烟；重要保护性因素是常食豆制品及哺乳。结论 新乡地区女性乳腺癌重要危险因素为良性乳腺疾病史及被动吸烟。     

ATM c.7570G>C is a high-risk allele for breast cancer

ATM is generally described as a moderate-risk breast cancer susceptibility gene. However, some of ATM variants might encounter higher risk. ATM c.7570G>C, p.Ala2524Pro, (rs769142993) is a pathogenic Finnish founder variant causative for recessively inherited ataxia-telangiectasia. At cellular level, it has been reported to have a dominant-negative effect. ATM c.7570G>C has recurrently been described in Finnish breast cancer families and unselected case cohorts collected from different parts of the country, but the rarity of the allele (MAF 0.0002772 in Finns) and lack of confirming segregation analyses have prevented any conclusive risk estimates. Here, we describe seven families from genetic counseling units with ATM c.7570G>C variant showing co-segregation with breast cancer. Further analysis of the unselected breast cancer cohort from Northern Finland (n = 1822), a geographical region previously indicated to have enrichment of the variant, demonstrated that c.7570G>C significantly associates with breast cancer, and the risk is estimated as high (odds ratio [OR] = 8.5, 95% confidence interval [CI] = 1.04-62.46, P = .018). Altogether, these results place ATM c.7570G>C variant among the high-risk alleles for breast cancer, which should be taken into consideration in genetic counseling.     

Predictors of long-term outcome following high-dose chemotherapy in high-risk primary breast cancer

We report on a predictive model of long-term outcome in 114 high-risk breast cancer patients treated with high-dose chemotherapy between 1989 and 1994. Paraffin-blocks from 90 of the 114 primaries were assessed for the presence of five risk factors: grade, mitotic index, protein expression of p53, HER2/neu, and oestrogen/progesterone receptor status; we could analyse the effect of risk factors in 84 of these 90 tumours. Seven-year relapse-free and overall survival was 58% (95% confidence interval 44-74%) and 82% (95% confidence interval 71-94%) vs 33% (95% confidence interval 21-52%) and 41% (95% confidence interval 28-60%) for patients whose primary tumours displayed > or =3 risk factors vs patients with < or =2 risk factors. For the entire group of 168 high-risk breast cancer patients, inflammatory stage IIIB disease and involved post-mastectomy margins were associated with decreased relapse-free survival and overall survival; patients treated with non-doxorubicin containing standard adjuvant therapy experienced worse overall survival (RR, 2.08; 95% confidence interval 1.04 to 4.16; P=0.04), while adjuvant tamoxifen improved overall survival (RR, 0.65; 95% confidence interval 0.41-1.01; P=0.054). Future trial designs and patient selection for studies specific for high-risk breast cancer patients should include appropriate prognostic models. Validation of such models could come from recently completed randomised, prospective trials.     

ATM haplotypes and breast cancer risk in Jewish high-risk women

While genetic factors clearly play a role in conferring breast cancer risk, the contribution of ATM gene mutations to breast cancer is still unsettled. To shed light on this issue, ATM haplotypes were constructed using eight SNPs spanning the ATM gene region (142 kb) in ethnically diverse non-Ashkenazi Jewish controls (n=118) and high-risk (n=142) women. Of the 28 haplotypes noted, four were encountered in frequencies of 5% or more and accounted for 85% of all haplotypes. Subsequently, ATM haplotyping of high-risk, non-Ashkenazi Jews was performed on 66 women with breast cancer and 76 asymptomatic. One SNP (rs228589) was significantly more prevalent among breast cancer cases compared with controls (P=4 x 10(-9)), and one discriminative ATM haplotype was significantly more prevalent among breast cancer cases (33.3%) compared with controls (3.8%), (P< or =10(-10)). There was no significant difference in the SNP and haplotype distribution between asymptomatic high-risk and symptomatic women as a function of disease status. We conclude that a specific ATM SNP and a specific haplotype are associated with increased breast cancer risk in high-risk non-Ashkenazi Jews.     

Screening of populations at high risk for breast cancer

The approach to screening patients at high risk for breast cancer has thus far been challenging to standardize, given limited high-level evidence in this population. The approach has evolved given the development of more effective screening modalities, including digital breast mammography, magnetic resonance imaging, and other emerging technologies. This review will discuss identification of high-risk patients, approaches to genetic counseling and testing, and evidence behind screening modalities and algorithms in this special population.     

Screening for breast cancer in a high-risk series

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer Institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammograpy was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, use of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.     

乳腺癌微钙化灶的研究新进展

乳腺微钙化灶是乳腺癌的常见影像学表现之一。通过回顾近期乳腺癌微钙化领域的相关研究,对乳腺癌微钙化灶的成分、形成机制、活检诊断方法、其与临床病理指标间的关系以及新辅助化疗对乳腺癌微钙化灶的影响进行综述,以期发现有待解决的问题和研究的方向。     

乳腺癌微转移的研究进展

微转移是乳腺癌早期即发生的行为，与预后密切相关。近年来，随着影像学、病理学、免疫组化技术及分子生物学技术的发展，乳腺癌微转移的诊断水平有了长足的进步。本文综述了乳腺癌微转移方面的最新进展。     

乳腺癌患者焦虑抑郁的研究进展

乳腺癌是女性常见的恶性肿瘤之一,严重影响患者生活质量,且发病率呈逐年上升趋势。在疾病治疗过程中,乳腺癌患者不仅会出现一系列生理症状,还常表现焦虑、抑郁等心理症状,甚至出现临床无法解释的躯体化障碍,常常被患者及临床医生所忽视。近些年来,随着生物-心理-社会医学模式的发展,临床医生逐渐认识到焦虑、抑郁等心理因素对乳腺癌发生、发展、治疗和转归的影响。本文就乳腺癌患者发生焦虑、抑郁的流行病学特点、影响因素、临床表现、诊断方法、可能的发生机制、治疗和转归等方面作简要综述。     

环氧合酶-2与乳腺癌的研究进展

环氧合酶(cyclcoxygenase,COX)是花生四烯酸合成前列腺素的限速酶。COX-2在多种肿瘤中表达上调,通过多种机制参与肿瘤的发生、发展和转移。近年来,COX-2与乳腺癌的关系研究逐渐成为乳腺癌治疗的新靶点。     

环氧合酶-2与乳腺癌的研究进展

环氧合酶（cyclcoxygenase,COX）是花生四烯酸合成前列腺素的限速酶。COX-2在多种肿瘤中表达上涮,通过多种机制参与肿瘤的发生、发展和转移。近年来,COX-2与乳腺癌的关系研究逐渐成为乳腺癌治疗的新靶点。