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.

Comparison of pathological characteristics in screen-detected and unscreened breast cancer

Objective: To investigate the role of breast cancer screening program in early diagnosis and treatment of breast cancer, and to provide a reference for the development of breast cancer screening program. Methods: In China, a cross-sectional breast cancer screening program has been developed in four cities of China, including Tianjin, Nanchang, Feicheng and Shenyang between July 2008 and September 2009. In this program, 67 cases of breast cancer were identified from 22 960 asymptotic women; during the same period, 1 547 unscreened patients with breast cancer were collected from Tianjin Medical University Cancer Hospital. Results: The proportion of ductal carcinoma in situ (DCIS) was 11.9% in the screen-detected cases and 6.8% in the unscreened patients (P = 0.136). Screen-detected tumors were significantly more frequent with an earlier stage, lower histological grade, tumor diameter smaller than 20 mm, lymph node-negative and non-metastasis compared to unscreened tumors (P = 0.003, P = 0.010, P = 0.008, P = 0.000 and P = 0.004, respectively). Conclusion: This study suggests that breast cancer diagnosed during the screening process has prognostically favorable tumor characteristics compared to breast cancer not experiencing screening.