110例乳腺间期癌的临床病理特征分析

目的 分析顺义区三轮乳腺癌筛查中110例间期癌患者的临床及病理特征。方法 将顺义区历年乳腺癌发病个案信息与北京市妇幼保健网络信息系统中适龄女性乳腺癌筛查数据进行关联,查询乳腺间期癌患者。将间期癌患者与同时期在我院乳腺中心就诊的乳腺癌患者进行特征比较。结果与门诊收治的原发性乳腺癌相比,间期癌患者年龄偏小、超声肿物较小,差异均有统计学意义（P＜0.05）。与病灶大小相近的门诊收治的乳腺癌患者相比,真正间期癌X线检查恶性钙化和浸润性导管癌的比例均较高,差异均有统计学意义（P＜0.05）。间期癌患者在乳腺癌筛查中转诊X线检查比例很低（0.91%）,而110例间期癌确诊时有103例接受了乳腺X线检查,其中53例（48.2%）存在恶性钙化表现。结论 乳腺癌筛查中,年龄偏小的女性更易发生间期癌。由于间期癌患者中接近50%在诊断时存在X线下恶性钙化表现,因而若在以超声检查为主的乳腺癌筛查过程中结合乳腺X线检查,或许可以避免部分间期癌的发生。     

乳腺癌筛查方法及模式的研究进展

乳腺癌筛查是提高乳腺癌患者生存率行之有效的方法。目前国内外常用的乳腺癌筛查方法有乳腺自我检查、临床乳腺检查、乳腺X射线摄影术（钼靶X射线摄影）、超声成像和磁共振成像检查等。本文将对这些筛查方法的特点及不同筛查方案在人群中的应用效果进行综述。     

亚洲国家及地区乳腺癌筛查指南的发展和实践

乳腺癌是严重威胁女性健康的主要疾病之一,近年来我国乳腺癌发病率逐年升高,乳腺癌筛查已被公认为可提高患者生存率和降低死亡率的有效手段。我国在人种及乳腺癌发病特点上有别于白人女性,因此亚洲各国乳腺癌筛查机制更具有借鉴性。本文回顾新加坡、日本、韩国、印度、中国台湾及香港等亚洲国家及地区制定乳腺癌筛查政策的历史经验及相关问题,分析比较不同国家及地区建立的不同筛查方案在人群中的应用效果,以探索我国乳腺癌普查的方式、频度及年龄范围,为我国制定乳腺癌筛查指南提供参考及依据。      

不同组织模式下乳腺癌筛查结果分析

背景与目的：近年来我国政府对乳腺癌筛查非常重视。本研究分析北京市顺义区乳腺专科和非乳腺专科医疗机构完成的3轮乳腺癌筛查结果,为公共卫生行政部门调整乳腺癌筛查组织模式提供科学依据。方法：乳腺癌普通筛查包括乳腺临床检查和乳腺超声检查,对于高危人群和普通筛查发现的可疑人员转诊至诊断单位行乳腺X线检查及后续诊断和治疗。顺义区乳腺癌筛查的组织模式分为2种,即顺义区妇幼保健院乳腺中心的专科组织模式和其他单位的非专科组织模式。采用非条件Logistic回归模型,对不同组织模式的乳腺癌检出率和间期癌发生率进行分析。结果：3轮筛查分别完成58 151、57 810和69 849例,检出乳腺癌25、10和30例,粗检出率为42.99/10万、17.30/10万和42.95/10万。第2轮和第3轮筛查中,专科模式的乳腺癌检出率是非专科模式的1.66和1.88倍(P均>0.05)。第2轮和第3轮筛查非专科模式乳腺间期癌的发生率均高于专科模式(65.94/10万 vs 31.20/10万,66.17/10万 vs 0),其中第2轮非专科模式间期癌的发生率是专科模式的2.47倍(P>0.05)。结论：不同筛查组织模式之间无论是乳腺癌的检出率还是间期癌的发生率均差异较大,差异无统计学意义可能与专科组织模式样本量尚不够大有关。本研究结果提示,大规模乳腺癌筛查以乳腺专科为主导的组织模式可能更有意义。     

乳腺癌机会性筛查规范路径专家共识

摘 要：乳腺癌是中国城市女性发病率最高的恶性肿瘤。研究证实通过群体性筛查能够提高乳腺癌的早期诊断率，从而降低乳腺癌的死亡率。机会性筛查与群体性筛查有一定的区别。乳腺癌机会性筛查是医生推荐给主动进行筛查的非肿瘤就诊患者或体检人员进行的乳腺癌相关筛查。为了推进乳腺癌机会性筛查的路径规范化，根据受检人员乳腺癌高危因素的不同，组织多学科专家针对筛查方案、筛查设备、人员要求、筛查流程、异常结果处理流程以及后续的预警提醒流程等关键环节进行归纳与整理，以期达到规范乳腺癌机会性筛查的方法和流程，提高乳腺癌早诊率的目的。     

乳腺癌筛查卫生经济学研究进展

乳腺癌是妇女常见恶性肿瘤,发病率逐年上升,巳成为威胁妇女的主要恶性疾病之一.筛查是恶性肿瘤二级预防的主要手段,理想的筛查方法应经济、简便、有效及可行.本文简要回顾了国内外乳腺癌筛查历史,并对乳腺X线摄影和乳腺超声等筛查手段的效用,以及普通人群和高危人群筛查方案的卫生经济学评价进行综述,初步探索适合中国国情的筛查方案.     

乳腺癌筛查研究进展

乳腺癌是危害全世界女性健康最常见的恶性肿瘤.乳腺癌筛查是公认的能够有效提高女性乳腺癌生存率的主要方法.目前国内外常用的乳腺癌筛查手段包括乳房X线摄影术(钼靶X线摄影)、超声成像、临床乳腺检查和磁共振成像等.本文对这些筛查手段的优缺点进行了比较,并对基于这些手段建立的不同筛查方案在人群中的应用效果和卫生经济学评价进行综述,以期为建立符合中国国情的具有成本-效果的女性乳腺癌筛查策略提供参考和依据.     

筛查与非筛查乳腺癌病理特征的比较

目的:探讨乳腺癌筛查在乳腺癌早期诊断和早期治疗中的作用,为中国开展乳腺癌筛查项目提供参考依据.方法:2008年7月-2009年9月在天津、南昌、肥城和沈阳这4个城市开展了横断面多中心乳腺癌筛查项目.在22 960例无临床症状妇女中最终确诊67例乳腺癌病例,并收集同期同年龄段至天津医科大学附属肿瘤医院就诊并确诊的1 547例乳腺癌患者的资料.结果:在筛查出的乳腺癌患者中,原位癌占11.9％;而在临床就诊而确诊的乳腺癌患者中,原位癌占6.8％(P=0.136).与临床就诊而确诊的乳腺癌患者相比,筛查出的浸润性乳癌癌患者中,早期、低病理分级、肿瘤较小、淋巴结阴性和无远处转移者更多(P=0.003,P=0.010,P=0.008,P=0.000和P=0.004).结论:与非筛查的乳腺癌患者相比,通过开展乳腺癌筛查项目检查出的乳腺癌患者具有较好的病理特征.     

山东省肥城市2008-2011年乳腺癌筛查结果分析

目的:分析2008-2011年肥城市乳腺癌筛查项目结果,了解肥城市乳腺癌发病情况,探讨理想的乳腺癌筛查模式.方法:方案1对全部筛查对象进行临床乳腺检查和超声检查,阳性和可疑者进一步行钼靶X射线检查;方案2对3 000名45～64岁城市受检者采用临床、超声和钼靶X射线检查(MAM)联合筛查;所有乳腺癌病例最终经病理确诊.采用单因素x2检验和筛检试验进行资料分析.结果:肥城市近4年初筛人群乳腺癌总体检出率为122.3/10万(26/21 256),复查人群检出率为66.8/10万(3/4 493).标化后城市妇女各年龄段乳腺癌检出率均远高于农村妇女,城市妇女总的标化检出率为168.6/10万,农村妇女总的标化检出率为3.4/10万.农村妇女对项目的参与度较低,且早期癌发现率较低.方案1与方案2对乳腺癌的检出率差异无统计学意义,但前者相对后者更加经济有效.结论:肥城市乳腺癌检出率相对较高,应加强和规范农村妇女乳腺疾病的普查和诊治工作,临床检查、B超筛检高危人群进行钼靶X射线检查的模式具有经济、早期癌检出率高的特点,适合在基层或社区推广应用.     

依托妇幼卫生服务体系建立乳腺癌筛查机制

目的探讨妇幼卫生服务网络在乳腺癌筛查中的作用。方法采取随机整群抽样的方法,在武汉市中心城区抽取35~59岁妇女33 019名为研究对象,利用妇幼卫生服务网络对筛查工作进行组织管理,采用乳腺临床体检、钼靶X线摄片和彩超检查相结合的筛查方案,所有病变诊断及转归的判定均以组织病理学检查为依据。计算筛查率、复查率和乳腺癌检出率等指标,评价妇幼卫生服务体系对乳腺癌筛查的作用。结果33 019名妇女中,30 478名妇女参与了乳腺癌筛查,筛查率为92.30%;钼靶或彩超的复查率为92.47%。通过临床检查、钼靶和彩超联合检查的乳腺癌或可疑癌患者均接受手术治疗,最终25人确诊为乳腺癌,乳腺癌检出率为82.03/100 000。结论利用妇幼卫生服务网络组织乳腺癌筛查,提高了人群顺应性,技术力量能够得到整合,大大提高乳腺癌筛查的质量。     

The association between the pre-diagnosis mammography screening interval and advanced breast cancer

BACKGROUND: While screening has been demonstrated to reduce breast cancer mortality, the optimal screening interval is unknown. We designed a study to determine the risk of an advanced breast cancer diagnosis by varying the interval between mammograms. METHODS: We reviewed a single state's mammography records of women diagnosed with breast cancer between 1994 and 2002. The pre-diagnosis screening interval was the number of days between the last two eligible mammograms preceding a cancer diagnosis. The interval was classified as annual (0.75-1.49 years), biennial (1.5-2.49 years) or longer (exceeding 2.49 years). Advanced breast cancer was >or=stage IIB, tumor size >2 cm, or >or=one lymph node with cancer. RESULTS: The probability of an advanced breast cancer diagnosis did not differ between women with an annual pre-diagnosis screening interval and women with a biennial interval (21.1% vs. 23.7%, P=0.262). A longer pre-diagnosis screening interval was weakly associated with advanced breast cancer (21.8% for intervals 0.75-2.49 years vs. 26.8% for longer intervals, P=0.070). In multivariate analysis, we found an interaction between the pre-diagnosis screening interval and age. Among women 50 years or older, the risk of an advanced breast cancer diagnosis risk was higher for women with a pre-diagnosis screening interval exceeding 2.49 years compared to women with shorter screening intervals (OR 1.99 [1.02-3.90]). CONCLUSIONS: We found no difference in advanced breast cancer rates between women using mammography annually or biennially. Among women 50 years or older, the advanced breast cancer rate increased when the pre-diagnosis screening interval exceeded 2.49 years.     

Individually tailored screening of breast cancer with genes,tumour phenotypes,clinical attributes,and conventional risk factors

Background:

We demonstrated how to comprehensively translate the existing and updated scientific evidence on genomic discovery, tumour phenotype, clinical features, and conventional risk factors in association with breast cancer to facilitate individually tailored screening for breast cancer.

Methods:

We proposed an individual-risk-score-based approach that translates state-of-the-art scientific evidence into the initiators and promoters affecting onset and subsequent progression of breast tumour underpinning a novel multi-variable three-state temporal natural history model. We applied such a quantitative approach to a population-based Taiwanese women periodical screening cohort.

Results:

Risk prediction for pre-clinical detectable and clinical-detected breast cancer was made by the two risk scores to stratify the underlying population to assess the optimal age to begin screening and the inter-screening interval for each category and to ascertain which high-risk group requires an alternative image technique. The risk-score-based approach significantly reduced the interval cancer rate as a percentage of the expected rate in the absence of screening by 30% and also reduced 8.2% false positive cases compared with triennial universal screening.

Conclusion:

We developed a novel quantitative approach following the principle of translational research to provide a roadmap with state-of-the-art genomic discovery and clinical parameters to facilitate individually tailored breast cancer screening.     

Mass screening for breast cancer in Japan

To establish effective mass screening projects for breast cancer, our study group (Tominaga group) was co-sponsored by the Ministry of Welfare. From 1968 to 1986, 643,513 women at the initial screening and 719,189 women at the subsequent screening were examined by physical examination. Abnormalities were found in 24,864 (3.9%) and 23,880 (3.3%) of these women, respectively. Cancer was detected in 833 women (detection rate 0.13%) and 428 women (0.06%), respectively. To establish the criteria for assessing the life-prolonging effect of mass screening for breast cancer, clinical stage and prognosis of breast cancer detected by mass screening were compared with those for matched patients in outpatients clinics. Early stages were significantly more common in the patients detected by mass screening. The 5-year survival rate was significantly higher in the patients detected by mass screening (91.7% vs. 85.6%; P less than 0.01), but the difference with the other group was not significant (80.5% vs. 78.1%). Women who had conducted breast self-examination (BSE) showed a higher survival rate than those who had not. We were not able to confirm the general belief that interval cancer is more aggressive in nature and shows a poorer prognosis than the cancer detected through periodic screening.     

What is the optimum interval between mammographic screening examinations? An analysis based on the latest results of the Swedish two-county breast cancer screening trial.

Further results are presented from the Swedish two-county breast cancer screening trial. The reduction in the rate of advanced cancers and of breast cancer mortality in the group allocated to screening when compared to the control group has accelerated with a further year of follow-up. Mortality due to other causes and the rate of other cancers remains similar in the two groups. Attention has been focused on the rate at which cancers start re-emerging among women with negative mammograms. Among women over 50 years of age at entry to the study, relatively few interval cancers are seen in the first two years after a screening test; in the third year the rate rises to nearly 50% of the comparable rate in the control group. Among women aged 40-49 years at entry, by contrast, the rate of interval cancers even in the first post screening year is nearly 40% of that in the controls and in the second year nearly 70%. In older women in the group allocated to screening, much of the breast cancer mortality comes from the refusers and little from the interval cancers; in younger women the picture is reversed. The implications for screening policy, including the interscreening interval are discussed.     

Estimation of natural history parameters of breast cancer based on non-randomized organized screening data: subsidiary analysis of effects of inter-screening interval, sensitivity, and attendance rate on reduction of advanced cancer

Estimating the natural history parameters of breast cancer not only elucidates the disease progression but also make contributions to assessing the impact of inter-screening interval, sensitivity, and attendance rate on reducing advanced breast cancer. We applied three-state and five-state Markov models to data on a two-yearly routine mammography screening in Finland between 1988 and 2000. The mean sojourn time (MST) was computed from estimated transition parameters. Computer simulation was implemented to examine the effect of inter-screening interval, sensitivity, and attendance rate on reducing advanced breast cancers. In three-state model, the MST was 2.02 years, and the sensitivity for detecting preclinical breast cancer was 84.83%. In five-state model, the MST was 2.21 years for localized tumor and 0.82 year for non-localized tumor. Annual, biennial, and triennial screening programs can reduce 53, 37, and 28% of advanced cancer. The effectiveness of intensive screening with poor attendance is the same as that of infrequent screening with high attendance rate. We demonstrated how to estimate the natural history parameters using a service screening program and applied these parameters to assess the impact of inter-screening interval, sensitivity, and attendance rate on reducing advanced cancer. The proposed method makes contribution to further cost-effectiveness analysis. However, these findings had better be validated by using a further long-term follow-up data.     

Histopathologic indicators of breast cancer biology: insights from population mammographic screening

Histopathologic features of breast cancer such as tumour size, grade and axillary lymph node (LN) status variably reflect tumour biology and time. Recent evidence suggests that the biological character of breast cancer is established at an early stage and has a major impact on clinical course. The aim of this study was to distinguish the impact of biology on breast cancer histopathology by comparing features of breast cancers diagnosed following population mammographic screening with prevalent vs incident detection and screening interval. Central histopathology review data from 1147 cases of ductal in situ and/or invasive breast cancer were examined. Size, grade and LN status of invasive cancers were positively correlated (P < 0.001). Prevalent invasive cancers were larger (P < 0.001) and more likely to be LN positive (P = 0.02) than incident cases, but grade was not associated with screening episode (P = 0.7). Screening interval for incident cancers was positively associated with invasive cancer size (P = 0.05) and LN status (P = 0.002) but not grade (P = 0.1). Together, these data indicate that biology and time both impact on size and LN status of invasive breast cancer, but grade reflects biology alone. In view of the clinical importance of breast cancer biology, grade as its most direct indicator assumes particular significance.     

Comparisons of interval breast cancers with other breast cancers detected through mass screening and in outpatient clinics in Japan

In a nation-wide collaborative study on mass screening for breast cancer, we collected 152 cases of interval breast cancer diagnosed at 35 hospitals or clinics distributed throughout Japan. The definition of interval breast cancer used in the present study is "breast cancer cases which were diagnosed as having 'no malignant findings' in a previous screening for breast cancer but subsequently diagnosed as 'breast cancer' at a hospital or medical clinic within two years of the previous screening." The clinical stages and prognoses of these interval cancer were analyzed and compared with those of other breast cancers detected through mass screening and in outpatient clinics. In the clinical staging of interval breast cancer, Tis (non infiltrating cancer) accounted for only 2.1%, compared to 8.0% in cases detected through mass screening. At stage I 43.4% were interval breast cancers compared to 32.9% breast cancers detected through mass screening and 25.4% diagnosed in outpatient clinics. The stage differences between interval breast cancers and breast cancers detected through mass screening were not statistically significant. Five-year survival rates were 85.6% for interval breast cancers, 91.7% for breast cancers detected through mass screening and 84.7% for breast cancers diagnosed in outpatient clinics. Ten-year survival rates were 75.9, 80.5 and 78.1%, respectively, suggesting the interval breast cancer cases to show a similar prognosis to that of breast cancer cases diagnosed in outpatient clinics. The differences in five- and 10-year survival rates among the three groups were not statistically significant. From the present study we were not able to confirm the general belief of interval cancer being more aggressive in nature and showing a poorer prognosis than cancer detected through periodic screening. The reasons for this are discussed.     

Accuracy of breast screening among women with and without a family history of breast and/or ovarian cancer

SummaryObjectives To compare interval cancer rates, sensitivity and specificity of breast cancer screening between women with moderate or strong family history and women without a family history.Methods From 1996 to 1997, 115,460 women aged 50 to 69 screened by the Ontario Breast Screening Program, offering eligible women screening with mammography and clinical breast examination, were examined. Women were followed for up to 12 months after their screening examination. Family history definitions were based on the number of affected first degree relatives and their ages at diagnosis. Multivariate analysis was conducted to adjust for potential confounding variables.Results Interval cancer rates increased across family history groups and were greatest in women with a strong family history. The rate ratio (RR) for interval cancer rate in women with a strong family history compared to women without a family history approached significance (RR=2.28, 95% confidence interval (CI) 0.97–5.34), while for women with a moderate family history it did not (RR=1.37, 95% CI 0.62–3.04). A slightly but not significantly lower sensitivity was observed in women with a strong family history compared to women without a family history. There was little variation in specificity across family history groups.Conclusions Screening was able to detect a large proportion of invasive breast cancers in women with a family history, indicating their potential to benefit from regular breast cancer screening. However, due to increased interval cancer rates, screening with one-year intervals may be important even in an older population of women with a family history.