乳腺癌筛查的思考

乳腺癌筛查虽在西方世界获得降低死亡率的实效,但有关其利弊之争迄今未息。本文结合中国的实际,就筛查年龄段的取舍、城乡发病的考虑、筛检方法的选择,以及组织形式与筛查方案等进行了讨论,提出了增利减弊的建议。     

乌鲁木齐市2014—2018年度乳腺癌筛查结果分析

目的 对乌鲁木齐市乳腺癌高危人群进行筛查,探讨筛查的参与率,超声和X线摄影检查对乳腺疾病的检出率及乳腺癌的早诊率。方法 在40~74岁乌鲁木齐市女性居民中,通过防癌风险评估问卷评估出乳腺癌高危人群;经知情同意后,40~44岁采用超声检查,BI-RADS 3级以上结果加做X线摄影检查;45岁以上采用超声联合X线摄影检查。BI-RADS 3级为可疑阳性,BI-RADS 4级及以上为阳性;对检查结果进行分析。结果 问卷调查共评估出乳腺癌高危人群27 704人,实际完成筛查11 752人,参与率为42.4%;其中50~59岁年龄组的参与率最高(46.3%),不同年龄组间参与率差异有统计学意义(P＜0.001)。超声检查占位检出率为27.1%,乳腺X线检查占位检出率为61.3%,联合检查占位检出率为68.4%,不同检查技术占位检出率差异有统计学意义(P＜0.001)。各年龄段乳腺X线占位检出率均高于超声检查,联合检查的占位检出率最高,各年龄段不同检查技术占位检出率差异有统计学意义(P＜0.001)。三种技术比较,不同年龄段乳腺超声+X线摄影联合检查可疑阳性和阳性检出率均较高,不同检查技术在各年龄段中阳性病变检出率差异有统计学意义(P＜0.001)。阳性病变中随访到39人进行了病理检查,诊断为乳腺癌,检出率为0.33%(332/10万),早诊率为79.5%。结论 以高危风险评估为基础,评估出高危人群,再联合超声及X线检查,可以提高早期乳腺癌的检出率。     

乳腺癌社区筛查策略的探讨

目的探讨乳腺癌社区筛查的方法。方法对3个社区共13378人乳腺癌筛查按社区分成3组,分别采取组1：社区宣教＋医院免费体检以及推荐钼钯检查;组2：发放免费医院体检表以及推荐钼钯检查;组3：社区宣教＋推荐钼钯检查。统计各组来院检查率、钼钯摄片率、乳腺癌检出率。结果组1共发放免费体检表7973张,来院检查人数5176人,占64．92％。组2共发放免费体检表10097张,来院检查人数5267人,占52．16％。组3共发放免费体检表8013张,来院检查人数2935人,占36．63％。组1钼钯摄片数共1289人,占24．9％;组2钼钯摄片542人,占10．29％;组3钼钯摄片120人,占4．09％。3个社区实际发现乳腺癌21例,总发病率为80．51／10万。其中通过本次筛查发现13例。受筛查者到目前没有发现漏诊病例。组1诊断乳腺癌6例,组2诊断乳腺癌5例,组3诊断乳腺癌2例。结论社区宣教＋医院免费体检＋推荐钼钯检查是目前比较适合国情的乳腺癌筛查方法。     

乳腺癌的发病趋势及筛查

近几十年来，西方发达国家的乳腺癌发病率有不同程度的上升。虽然发展中国家乳腺癌的发病率较低，但全球乳腺癌的一半病例发生在发展中国家，其中中国、印度等国占了相当大的比例。因此，了解我国乳腺癌的发病趋势并采取相应对策已刻不容缓。一、乳腺癌的发病趋势乳腺癌是西方国家最常见的恶性肿瘤。据美国癌症协会估计，1994年全美国有18．2万新发乳腺癌病人，约4．6万名病人将死于该疾病。对于年龄40岁一55岁的美国妇女，乳腺癌超过心脏病而成为第一位死因。据美国国立癌症研究所监测、流行病学和最终结果项目（SEER）的资料，美国妇女…     

乳腺癌筛查结果分级标准初探

本文参照乳腺X线检查BI-RADS分级标准,设计了一套诊断标准化的分级系统,现作简要介绍,希望对今后乳腺癌的筛查研究工作有所帮助。     

各国乳腺癌筛查指南中一般风险对象筛查方案的比较

乳腺癌是全世界女性发病率最高的恶性肿瘤之一,现有证据证实可以通过有组织的人群筛查降低乳腺癌死亡率.全球多个癌症研究机构和专业组织已形成不同的乳腺癌筛查指南以规范群体筛查行为.针对一般风险对象,这些指南均推荐乳腺X射线摄影术作为筛查手段,而对于筛查间隔时间和筛查开始年龄的推荐则有所不同.关于开始筛查年龄,各个指南主要的争...     

通过唾液筛查乳腺癌

美国的科学家正在开发一种通过唾液筛查乳腺癌的方法，以便在癌变早期发现肿瘤，增加治愈机会。     

云南省成年妇女乳腺癌与宫颈癌筛查率及影响因素分析

摘 要：［目的］ 分析云南省妇女乳腺癌及宫颈癌的筛查率及影响因素。［方法］ 利用2015年中国成人慢性病与营养监测云南省调查数据,分析3428名女性调查对象乳腺癌及宫颈癌筛查率,采用基于复杂抽样的统计分析方法对筛查率及其95%CI进行加权估计,通过多因素Logistic回归模型分析影响筛查率的主要因素。［结果］ 云南省成年妇女乳腺癌筛查率为16.7%（95%CI：13.7%～20.1%）,其中40～69岁妇女乳腺癌筛查率为19.4%（95%CI：17.4%～21.4%）;成年妇女宫颈癌筛查率为21.4%（95%CI：19.4%～23.6%）,其中35～64岁妇女筛查率为24.8%（95%CI：22.1%～27.7%）。多因素分析结果显示,年龄是两癌筛查率的影响因素,35～59岁者乳腺癌筛查率较高,≥70岁者筛查率较低,35～49岁妇女宫颈癌筛查率较高,≥65岁者筛查率较低（P＜0.05）;其他少数民族与汉族相比,乳腺癌筛查率较低（P＜0.05）;文化程度越高的人群、已婚/同居者、城市妇女的两癌筛查率较高（P＜0.05）。［结论］ 云南省妇女两癌筛查率低于全国平均水平,扩展两癌筛查老年人群的年龄覆盖范围、扩大筛查项目覆盖面是目前提高云南省妇女两癌筛查率的主要途径。     

2015版美国癌症协会乳腺癌筛查指南解读

目的 简介2015年美国癌症协会(American Cancer Society,ACS)公布的乳腺癌筛查最新指南.方法 与2003版ACS指南相比,分析2015版ACS指南的更新要点;结合其他重要的国际乳腺癌筛查指南及中国实际情况,讨论2015版ACS指南存在的不足及可借鉴之处.结果 2015版ACS指南主要更新要点在于推荐乳腺癌发病平均风险女性应从45岁起常规进行乳房摄影术筛查,并且不推荐临床乳腺检查作为任何年龄平均风险女性的乳腺癌筛查方法.由于中国和欧美女性乳腺质地、体积和经济情况的差异,ACS推荐的乳腺癌筛查方案并不完全适用于中国女性.结论 在借鉴ACS指南基础上,应针对中国女性乳房生理特点及乳腺癌流行病学特征制定适用于我国的乳腺癌筛查指南.     

Application of Health Behavior Theories to Breast Cancer Screening among Asian Women

Background: Although breast cancer is a major public health worry among Asian women, adherence toscreening for the disease remains an obstacle to its prevention. A variety of psycho-social and cultural factorspredispose women to delay or avoidance of screening for breast cancer symptoms at the early stages when cureis most likely to be successful. Yet few interventions implemented to date to address this condition in this regionhave drawn on health behavior theory. Materials and Methods: This paper reviews the existing literature onseveral cognitive theories and models associated with breast cancer screening, with an emphasis on the workthat has been done in relation to Asian women. To conduct this review, a number of electronic databases weresearched with context-appropriate inclusion criteria. Results: Little empirical work was found that specificallyaddressed the applicability of health theories in promoting adherence to the current breast cancer preventionprograms Among Asian women. However, a few studies were found that addressed individual cognitive factorsthat are likely to encourage women’s motivation to protect themselves against breast cancer in this region ofthe world. The findings suggest that multi-level, socio-cultural interventions that focus on cognitive factors havemuch promise with this issue. Conclusions: Interventions are needed that effectively and efficiently target thepersonal motivation of at-risk Asian women to seek out and engage in breast cancer prevention. Concerningimplications, personal motivation to seek out and engage in individual preventive actions for breast cancerprevention among Asian women is a timely, high priority target with practical implications for communitydevelopment and health promotion. Further studies using qualitative, anthropologic approaches shaped forimplementation in multi-ethnic Asian settings are needed to inform and guide these interventions.     

Effectiveness of Mammographic Screening for Breast Cancer in Women Aged over 50 Years in Japan

The optimal age for effective screening of subjects for breast cancer by mammography in Japan was studied based on the results of two mammograpbic screening systems (systems I and II) in Tokushima Prefecture, System I consisted of visit screening using a bus equipped with a mammographic apparatus. System II consisted of central screening performed at Tokushima Health Screening Center. The examinees numbered 2,500 and 3,707 in systems I and II, respectively. There was a significant difference between the two screening systems in the age distribution of the examinees. The detection rates of breast cancer were 0.6% and 0.24% in systems I and II, respectively, which are 2–5 times higher than that (0.12%) obtained by conventional screening using physical examination alone. The detection rate increased especially in the sixth and seventh decades of life. The sensitivity of mammography screening was 93.3% in system I and 81.1% in system II. Higher sensitivity (100%) than that (73%) of screening by physical examination was obtained in women aged over 50. The proportion of stage I was 60% in system I and 66.7% in system II, compared with 32–65% in the United States and Europe. The rates of no nodal involvement were high, being 77.8% and 83.3% in systems I and II, respectively, compared with 57–71% in other countries. Breast-conserving therapy was applied to 18 of the 24 patients with breast cancer detected by the two screening systems. In addition, in Wolfe's classification of mammograms, the proportion of DY (mammary dysplasia) pattern was remarkably low, being 3.2% in the sixth decade and 0.8% in the seventh decade, compared with 16.6% in women aged 49 years. These results indicate that mammographic screening is effective in women aged over 50 years in Japan, as has been found in other countries.     

Perception of Breast Cancer Screening among Iranian Women without Experience of Mammography: A Qualitative Study

Background: In Iran, there are high rates of breast cancer. It is among the five most common cancers, thefirst among cancers diagnosed, and is the leading cause of cancer deaths among Iranian women. Objectives: Thepurpose of this qualitative study was to explore perception of breast cancer screening among Iranian women whohave never had a mammograph. Materials and Methods: The current study was part of a qualitative researchconducted by means of content analysis method and purposive sampling of 16 women over the age of 30 yearswho had not undergone mammography using individual semi-structured interviews. Interviews were recordedand transcribed verbatim. The data were under continuous consideration and comparative analysis in order toachieve data saturation. Results: After codification of data, three concept categories were achieved including: i)low awareness, ii) worries, and iii) lack of motivation. Conclusions: Although there is a tendency among Iranianwomen to participate in breast cancer screening, there is a powerful cultural belief that breasts are sexual organsthat should not be discussed publicly. Due to the incidence of breast cancer in Iranian women, it is critical thatbreast awareness education be performed by health care experts to explore the concepts of breast cancer andbreast cancer screening.     

Cultural,Religious and Socio-Ethical Misconceptions among Muslim Women towards Breast Cancer Screening: A Systematic Review

Introduction: Breast cancer is the most diagnosed cancer worldwide. With an estimated 685,000 deaths, female breast cancer was the fifth leading cause of cancer mortality worldwide, accounting for 6.9% of all cancer deaths. Previous studies have shown that late detection and delayed diagnosis are associated with advanced-stage breast cancer and poor survival. Factors contributing to non-adherence to breast cancer screening among women were elicited from previous studies. However, few studies have focused on the Muslim community, particularly Muslim women. As such, this systematic review aims to fill this gap by collecting information from studies conducted globally over the past ten years that examined cultural, religious and socio-ethical misconceptions about breast cancer screening among Muslim women. Methods: Following the PRISMA guidelines, literature searches were conducted systematically through various databases including PubMed, Science Direct, Scopus, Cochrane Library and Oxford Academic Journals. Article identification, screening steps and eligibility measures were meticulously performed throughout the review. Results: A total of 22 papers were appraised and included in this review. Five main themes were generated which were socio-ethical misconceptions, cultural and religious beliefs, cultural and religious barriers, stigmatization and fear of breast cancer impact. Eight sub-themes and 14 sub sub-themes were further elicited from the main themes. Conclusion: Muslim women have socio-ethical, cultural and religious misconceptions on what constitutes health and practices as well as on the nature and etiology of BC. Cultural barriers and religious values of Muslim women were indicated to influence their health behaviors such as upholding their modesty when choosing health interventions. BC stigma and fear were also found to be key sources of psychological distress that discouraged Muslim women from undergoing BC screening. The study suggests the implementation of holistic effort in educating Muslim women to increase BC screening rate.     

Awareness Level about Breast Cancer Risk Factors,Barriers, Attitude and Breast Cancer Screening among Indonesian Women

Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortalityin Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatmentfor this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge aboutbreast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectionalstudy administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples wereselected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logisticmodel was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of thewomen, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associatedwith a lower knowledge of the risk factors. However, living in an urban area was significantly associated with betterattitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70%worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, andunmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion:Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more ruralareas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancerawareness campaigns. These findings suggest that additional education programs aiming to increase awareness andeducate the public are needed.     

乳腺癌责任保险普查的价值(附86例分析)

本文对1990年以来我们在北京市及近郊区妇女乳腺防癌责任保险普查中所检出的经病理证实的86例乳腺癌，从病变分期、年龄及普查的方法等方面进行了分析。认为通过乳腺癌责任保险连续普查普治，确实能够提高早期癌的检出率，明显降低35岁以下妇女乳腺癌的发生率、普查的重点人群年龄构成为35～60岁，高危年龄组在45～54岁之间。其内容包括：（1）防癌知识宣教；（2）临床触诊，近红外线扫描筛选，重点人群X线拍片等综合普查：（3）普治良性病变．被检人群五年内共普查三次，凡乳房有良性病变者，在治疗同时，3～6个月复查一次．     

Improved Performance of Adjunctive Ultrasonography After Mammography Screening for Breast Cancer Among Chinese Females

Introduction

Until now, no studies have investigated whether women other than those with dense breasts are suitable for adjunctive ultrasonography after negative mammography, and investigated whether all women with negative mammography are suitable for adjunctive ultrasonography.

Comparison of False Negative Rates among Breast Cancer Screening Modalities with or without Mammography: Miyagi Trial

False negative rates were compared in two screening modalities, physical examination with or without mammography, in an intervention study for women aged over 50 in Miyagi Prefecture. Thirty-five breast cancers were detected in 12,515 subjects who participated in the trial consisting of physical examination and mammography, whereas 44 breast cancers were detected in 50,105 subjects who received physical examination alone, so that the detection rates were 0.28% and 0.09%, respectively. Among 50,061 subjects who received physical examination alone, 8 women were diagnosed as having breast cancer within 12 months after the screening, while only one of 12,480 screenees receiving the combined modality was so diagnosed, implying false negative rates of 15.4% and 2.8%, respectively. When the screening sensitivity in the combined system was analyzed according to each single modality, the false negative rate provided by physical examination with mammography turned out to be 2.8%, significantly lower than that (33.3%) by the physical examination alone. Minimal breast cancers represented 25.7% of all screen-detected cancers in the combined modality, compared with 9.1% in the modality without mammography. The trial thus indicates that physical examination combined with mammography may be an appropriate modality for breast cancer screening in women aged over 50 on the basis of screening sensitivity.     

Beliefs and Behaviors of Breast Cancer Screening in Women Referring to Health Care Centers in Northwest Iran According to the Champion Health Belief Model Scale

Background: Breast cancer is the most common cancer in women. All ages are susceptible and more than90% of the patients can be cured with early diagnosis. Breast self-examination (BSE) and mammography can beuseful for this aim. In this study we examined the components of the Champion health belief model to identifyif they could predict the intentions of women to perform such screening. Materials and Methods: A total of380 women aged 30 and above who had referred to health-care centers were assessed for use of breast cancerscreening over the past year with a modified health belief model questionnaire. Logistic regression was appliedto identify leading independent predictors. Results: In this study 27% of the women performed BSE in thelast year but only 6.8% of them used mammography as a way of screening. There were significant differencesregarding all components of the model except for perceived severity between women that underwent BSE. overthe past year and those that did not. Findings were similar for mammography. Regression analysis revealedthat intentions to perform BSE were predicted by perceived self-efficacy and perceived barriers to BSE whileintentions to perform mammography were predicted by perceived barriers. Conclusions: This study indicatedthat self-efficacy can support performance of BSE while perceived barriers are important for not performingboth BSE and mammography. Thus we must educate women to increase their self-efficacy and decrease theirperceived barriers.