郑州市某机关女性公务员乳腺疾病体检分析

目的通过对某机关女公务员乳腺疾病体检分析,为开展妇女乳腺保健措施提供相应对策。方法对郑州市某机关1297名21~65岁女性公务员进行乳腺检查。结果乳腺疾病发病率为42.9%,其中乳腺囊性增生病发病率最高,占35.6%。并发现乳腺纤维腺瘤、乳腺囊肿、乳腺癌等疾病。21~39岁年龄组妇女乳腺疾病患病率占受检总人数的30.0%,高于其他年龄组。结论机关女性公务员乳腺疾病患病率较高,应加强乳腺疾病的普查和健康知识的宣传教育,从而提高女性公务员自我保健能力和健康水平。     

3960例乳腺普查结果分析

目的了解女性乳腺健康状况,增强女性自我保健意识,提高健康水平。方法对焦作地区部分企业单位女性整群抽样,对3960例妇女用电脑红外线扫描仪进行乳腺检测。结果3960例女性健康体检中检出异常种类6种,以乳腺增生症、乳头溢液为多见。结论妇女应定期进行乳腺疾病的检查。     

红外线透照检查在乳腺疾病诊断中的应用及护理

乳腺疾病是妇女常见病、多发病,其中以乳腺癌危害最大,居我国女性恶性肿瘤之首位,因此,未病先防,早期诊治至关重要。我科于2001年12月至2002年3月采用HRJ-IID型电脑红外乳腺检查仪(中国大恒公司生产)对266例乳腺疾病病人进行了电脑透光乳腺诊断(CDI),介绍如下。     

维汉哈族成年女性乳腺体检认知调查分析

目的了解新疆维汉哈族成年女性对定期乳腺体检认知行为及其影响因素,为制定特色化的早期干预提供依据。方法对行体检的158名成年女性采用自制的"乳腺疾病体检相关知识问卷"进行调查。结果认知行为总分为(10.5±6.1)～(22.9±5.9)分,汉族最高,维族次之,哈族最低(均P<0.05);影响女性乳腺体检认知行为的因素,汉族有文化水平、是否患过乳腺疾病和职业,哈族有年龄和文化程度,维族有文化水平和职业(均P<0.05)。结论汉哈族成年女性乳腺体检认知行为水平偏低,哈族、文化程度低、工人及其他职业、年龄偏大者更为明显,应进行针对性干预,提高各族妇女乳腺体检的认知及正确行为。     

威海市30岁以上妇女乳腺疾病普查结果分析

目的：通过对威海地区30岁以上妇女乳腺疾病普查结果进行分析,探讨乳腺疾病与各种发病因素的关系,为乳腺疾病的防治提供流行病学依据。方法：选取2005年3月-2008年3月进行乳腺普查的3 246例威海女性,将其按乳腺增生症、乳腺纤维腺瘤及乳腺癌进行分组,分析3种乳腺疾病的发生与患者年龄、初潮年龄、哺乳史、饮食习惯及职业的关系。结果：乳腺增生症、乳腺纤维腺瘤、乳腺癌发病率分别为44.30%、9.67%和0.15%。乳腺增生症及乳腺纤维腺癌低年龄组发病率明显高于高年龄组（P〈0.05）。初潮年龄早、无哺乳史、偏荤饮食及无固定职业者乳腺增生症发病率高（P〈0.05）。乳腺纤维腺瘤发病率与初潮年龄、哺乳史无关（P〉0.05）,偏荤饮食者及教师发病率高（P〈0.05）。乳腺癌发病率与以上因素无关（P〉0.05）。结论：乳腺疾病的发生是多种因素共同作用的结果,改变某些不良的生活习惯,可能会使广大妇女远离乳腺疾病,甚至远离乳腺癌。     

手法检查配合红外线扫描对乳腺疾病的诊断价值

摘要：探讨乳腺疾病的诊断方法，采用手法检查并与红外线扫描相结合，检查妇女2 679人。结果示有乳腺疾病患2 617例，占检查人数的97.69%。其中疑诊乳癌75例，经手术病检证实为69例，诊断符合率92.0％。提示红外线扫描能以其无创、方便、血管图像清晰及对乳腺肿块性质有较好的分辨力而适用于乳腺疾病的检查。但临床医师必须与认真、细致的触诊相配合，并全盘考虑病史和易患因素，方能最大限度地发现乳腺疾病。     

中年妇女不可忽视乳房肿块

乳房肿块是妇女乳腺疾病最常见的临床表现。有良性、恶性之分。良性者以乳腺纤维腺瘤、乳腺大导管乳头状瘤、乳腺囊性增生病等多见。恶性者以乳癌最为常见,也是女性发病率最高的恶性肿瘤。     

高频彩超和数字化钼靶摄片联合MRI在乳腺癌早期诊断中的价值

乳腺癌是危害妇女身心健康最常见的恶性肿瘤之一,近年来流行病学资料显示其发病率呈不断上升的趋势[1].目前乳腺彩超、乳腺X线钼靶摄片仍然是乳腺癌诊断及普查广泛采用的检查方法,但对于＜2 cm的早期乳腺癌诊断比较困难,具有较高的漏诊率.近年来,随着核磁共振成像(magnetic resonance imaging,MRI)技术的不断发展,MRI特别是增强MRI已成为最有前途的乳腺癌诊断手段,甚至能够检出彩超、钼靶摄片及临床体征阴性的隐匿性早期乳腺癌.为了探讨高频彩超、数字化钼靶摄片联合乳腺MRI在乳腺癌早期诊断中的价值,对224例早期乳腺癌患者的影像资料进行回顾性分析和总结,报道如下.     

2013年北京市通州区乳腺疾病筛查结果分析

目的了解本区妇女的自我保健意识及各种乳腺病变尤其是乳腺癌的患病情况,为今后的妇女病防治重点及周期性筛查方案提供理论依据。方法采用统一诊断标准,统一问卷。乳腺检查以手诊、超声检查、钼靶X线检查及病理检查相结合的方法。结果查出乳腺增生13390例;乳腺纤维腺瘤551例;其他乳腺良性疾病1878例;乳腺癌癌前病变3例;乳腺癌4例;在研究职业与乳腺疾病的关系中发现,企事业单位职工患乳腺疾病的比例最高,其他依次为公务员和老师,其他以及农民。结论通过开展乳腺癌普查工作,普及了乳腺癌知识,提高了广大妇女自我保健意识。     

雌激素受体共调节因子及其在子宫内膜癌中的研究和临床意义

子宫内膜癌是女性生殖系统常见三大恶性肿瘤之一,近年随着内分泌代谢性疾病的增加,该病发病率呈现上升趋势;流行病学调查显示,子宫内膜癌多发生于绝经后妇女,高发年龄为58～61岁,绝大多数为腺癌.     

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??Further discussion on the clinical problems of "breast hyperplasia" WANG Fei??YU Zhi-gang. Department of Breast Surgery, the Second Hospital of Shandong University, Jinan 250033,China
Corresponding author: YU Zhi-gang, E-mail:yzg@medmail.com.cn
Abstract Breast hyperplasia is one of the most common female benign breast diseases in clinical practice, and it has a wide range of clinical manifestation and pathological changes. Currently, there are a lot of controversies as to the definition, classification, diagnosis and treatment of breast hyperplasia. Because of the complicated pathological changes and inconsistent prognosis, breast hyperplasia should be more often considered as a group of diseases rather than a single disease. However, considering the absolute and objective risk of concomitant or subsequent breast cancer, comprehensive assessment of clinical history, physical examination, imaging tests and possible biopsy should be recommended, and subsequent treatment should be classified. Based on multidisciplinary cooperation including breast clinicians, radiologists and pathologists, surgeons should pay more attention to the screening of patients who need clinical intervention especially surgical intervention.     

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??Consensus and controversy in the diagnosis and treatment of breast benign diseases DUAN Xue-ning.Breast Disease Center,Peking University First Hospital,Beijing 100034,China
Abstract The prevalence of breast malignancy increases rapidly in China nowadays. Prevention and treatment of breast cancer has received more and more attention from the government, the academic circles and the public. Meanwhile, early detection and timely treatment of breast malignancy remains the focal point. Among the numerous inducements, breast benign diseases, such as breast hyperplasia, non-lactation mastitis, fibroadenoma and intraductal papilloma, are closely related with breast cancer. Several important issues about breast benign disease are widely concerned, including the risk of breast cancer and the standard diagnosis and treatment. With the transformation of medical mode from experience medicine to evidence-based medicine, the diagnosis and treatment process of breast benign disease should be revised for the accurate diagnosis and standard treatment. The expert consensus on breast benign disease has incorporated opinions from experts of pathology, radiology and clinical medicine to provide the best guidance for clinical practice.However,the process of diagnosis and treatment of breast benign diseases remains controversial.Its understanding will continue to improve.The relevant evidence will be updated constantly.     

Presentation and diagnosis of adolescent breast disease

Breast disease in the adolescent female is fortunately uncommon, with most presenting lesions being benign. The type and frequency of breast problems in young women less than 20 years of age are discussed in this paper. There were 634 adolescent females (9-19 years) referred to the Wesley Breast Clinic between January 1990 and December 1999. Of these, 62.6% were aged 18-19 years. The commonest reason for referral was a lump or thickening in the breast (n=554, 87.4%). Six hundred and nineteen females had ultrasound performed, with 59% showing no abnormality. The commonest abnormality in the remainder was probable fibroadenoma (n=162). Twenty-two percent of the females in the study had fine needle aspiration performed; none showed suspicious cytology. Twenty-three females had an excision biopsy following their initial visit. Three of these were found to have benign phyllodes tumour. There were no malignancies detected, although one female had previous DCIS diagnosed elsewhere.     

Osteoporosis and breast cancer

Osteoporosis affects one in three women after the menopause and the incidence of osteoporotic fractures increases steadily throughout life. Breast cancer is the most common cancer in women, both before and after the menopause. In younger women, recovery from breast cancer has been achieved using aggressive chemotherapy and radiotherapy that can adversely affect bone tissue or induce premature menopause. In postmenopausal women, breast cancer and osteoporosis are common, and although both are dependent on estrogens this leads to conflicting implications for the diagnosis and treatment: estrogens reduce the risk of fractures but increase the risk of breast cancer. Estrogen supplementation is, therefore, contraindicated in patients with a history of breast cancer. Selective estrogen response modifiers (SERMs) hold great promise, as they decrease both the fracture risk via an estrogen-agonist effect on bone and the breast cancer risk via an estrogen-antagonist effect on the breast tissue. SERMs can be used after successful treatment for breast cancer. Bisphosphonates, which are potent bone resorption inhibitors, are widely used both in cancer patients and in the prevention and treatment of spinal and peripheral osteoporotic fractures. Contraindications are exceedingly rare, and the satisfactory safety profile of these agents can be expected to improve further with newly developed modes of administration. Whether the bisphosphonates currently used to treat osteoporosis (alendronate and risendronate) have beneficial effects on skeletal events related to cancer progression remains to be determined, however. In sum, selection of the optimal treatment for osteoporosis in a patient with breast cancer involves assessment of the risk/benefit ratio of each treatment option, based on patient age, other risk factors for osteoporosis, and the stage of breast cancer progression.     

Breast cancer and ethnicity: strong association between reproductive risk factors and estrogen receptor status in Asian patients - a retrospective study

Breast cancer characteristics vary in racial/ethnic groups. Reproductive risk factors have been associated with estrogen receptor positive disease. We examined the association between reproductive risk factors and receptor status in different racial/ethnic groups to determine if some of the variation can be explained by a different reproductive risk profile. A retrospective chart review of all new breast cancer cases presenting to Elmhurst Hospital Center (Elmhurst, NY) between 1997 and 2004 was conducted. Data including patient characteristics and tumor characteristics were obtained. Four hundred ninety-nine patients were divided into two groups: the first group consisted of patients with estrogen positive disease and the second of those with estrogen negative disease. Association between reproductive risk factors and estrogen receptor status was examined for each racial group. There was a significant variability in patient age, age at menarche, parity, rates of nulliparity, age at first birth, and rates of menopause between the different ethnic groups. We found a strong, statistically significant association between reproductive risk factors and estrogen positive disease in the Asian group, where 96% of breast cancer patients who were either nulliparous or had late onset of first childbirth were found to have estrogen positive disease, whereas only 52% of those without these risk factors were found to be estrogen positive. For black patients the rates were 55% versus 56%, for Hispanic patients 64% versus 61%, and for non-Hispanic whites 74% versus 81%. In our patient population, differences in breast cancer characteristics could not be ascribed to a different reproductive risk pattern.     

Clinical characteristics of breast cancer patients in Korea in 2000

HYPOTHESIS: Breast cancer in Korea continues to rise year by year, and its clinical features will become closer to those now observed in Western countries. DESIGN: Nationwide multicenter survey of the Korean Breast Cancer Society in 2000. PARTICIPANTS: A total of 5401 patients (median age, 46 years) with newly diagnosed breast cancer who underwent surgery at 38 university and 45 surgical training hospitals. MAIN OUTCOME MEASURES: All participating hospitals provided the essential data, including sex, age, the surgical method used, and the American Joint Committee on Cancer classification to determine the clinical characteristics of breast cancer and to compare the results with those of previous surveys conducted in 1996 and 1998 to obtain an epidemiological pattern of breast cancer in Korea. RESULTS: An estimated crude incidence was 23/100 000 patients. Premenopausal women younger than 50 years constituted 61.2%. Of the study population, 71.5%underwent mastectomy; 27.1%, breast-conserving surgery; and 1.4%, other surgical treatments. In all, 52.8% were diagnosed as having stage II disease (American Joint Committee on Cancer classification), and the proportion of early cancer (stages 0 and I) was 31.5%. Comparisons with 1996 and 1998 results indicated that the number of patients with breast cancer is increasing. Mastectomies occurred less frequently and breast-conserving surgery more frequently (P<.001), and we noted an increase in the proportion of early cancer (P<.001). The number of patients with risk factors such as early menarche (P =.003), late menopause (P =.01), a high-fat diet (P =.048), and familial history of breast cancer (P =.046) was also found to have significantly increased. CONCLUSIONS: Although our epidemiological survey was limited in terms of its duration, our findings suggest that the incidence of breast cancer in Korea will continue to rise and that the clinical features will become closer to those now observed in Western countries.     

乳腺良性疾病诊治共识与争议

我国乳腺癌发病率呈快速上升趋势,预防乳腺癌的发生、早期发现和及时治疗成为关注焦点。在众多乳腺癌相关因素中,研究乳腺增生症、非哺乳期乳腺炎、乳腺纤维腺瘤及导管内乳头状瘤等乳腺良性疾病与乳腺癌之间的患病风险,规范其临床诊断与治疗原则尤为重要。中华预防医学会妇女保健分会乳腺保健与乳腺疾病防治学组组织国内临床医学、医学影像学及病理学等多学科专家在文献复习的基础上进行了深入讨论,根据求同存异的原则,针对上述疾病的诊治原则形成共识。但乳腺良性疾病的诊治程序仍存在争议,对其认识也将继续完善,相关证据亦会不断更新。     

Mammographic Density and Estimation of Breast Cancer Risk in Intermediate Risk Population

It is not clear to what extent mammographic density represents a risk factor for breast cancer among women with moderate risk for disease. We conducted a population‐based study to estimate the independent effect of breast density on breast cancer risk and to evaluate the potential of breast density as a marker of risk in an intermediate risk population. From November 2006 to April 2009, data that included American College of Radiology Breast Imaging Reporting and Data System (BI‐RADS) breast density categories and risk information were collected on 52,752 women aged 50–69 years without previously diagnosed breast cancer who underwent screening mammography examination. A total of 257 screen‐detected breast cancers were identified. Logistic regression was used to assess the effect of breast density on breast carcinoma risk and to control for other risk factors. The risk increased with density and the odds ratio for breast cancer among women with dense breast (heterogeneously and extremely dense breast), was 1.9 (95% confidence interval, 1.3–2.8) compared with women with almost entirely fat breasts, after adjustment for age, body mass index, age at menarche, age at menopause, age at first childbirth, number of live births, use of oral contraceptive, family history of breast cancer, prior breast procedures, and hormone replacement therapy use that were all significantly related to breast density (p < 0.001). In multivariate model, breast cancer risk increased with age, body mass index, family history of breast cancer, prior breast procedure and breast density and decreased with number of live births. Our finding that mammographic density is an independent risk factor for breast cancer indicates the importance of breast density measurements for breast cancer risk assessment also in moderate risk populations.     

Worry and risk perception of breast cancer in a prevention trial of low dose tamoxifen in midlife postmenopausal hormone users

ObjectiveThere is increasing interest in combining postmenopausal hormone therapy (HT) and SERMs in midlife women. We previously showed that refusal to participate in a prevention trial of low dose tamoxifen in HT users was associated with higher worry about breast cancer. Given this counterintuitive finding, we studied which factors influenced worry and risk perception of breast cancer.MethodsWe assessed the relationships of breast cancer worry and risk perception with age, age at menopause, Gail risk, education, adherence to mammographic screening, BMI, smoking, physical activity, alcohol use, anxiety and depression in 457 midlife HT users who were eligible to participate in the trial.ResultsWomen with menopause <48 years were more worried about breast cancer than women with menopause >52 years (OR = 5.0, 95% CI, 1.2–21.1). Worry was also associated with high absolute risk perception and former smoking. Factors associated with higher risk perception were age>60 years, at-risk life style, worry about breast cancer and depression.ConclusionsThe inverse association between early menopause and worry about breast cancer is in contrast with the known protective effect of early menopause on breast cancer risk and seems to reflect a feeling of aging and disease vulnerability. Our findings indicate that worry about cancer has an affective construct which is independent of breast cancer biology but is engaged in health decision making. Increasing breast cancer risk awareness in subjects high in worry without a plan of emotional coping may therefore be counterproductive because of avoidant attitudes.