乳房X光摄影发现乳癌:对年长妇女有帮助


  【24drs.com】根据在线发表于8月5日放射学期刊的一篇研究,虽然一般未建议75岁以上妇女进行乳房X光摄影,但对这个年龄层妇女可能是有帮助的。
  
  研究者报告指出,相较于让这些病患自己或她们的医师检测,使用乳房X光摄影侦测75岁以上妇女的乳癌有许多优点;特别要提的是,仪器侦测到的乳癌是比较初期的,所需治疗较少,5年疾病特定存活率较佳。
  
  西雅图华盛顿大学公卫与社区医学院客座助理教授Judith A. Malmgren博士等研究者写道,应告诉这些妇女,使用乳房X光摄影检查可以有比较好的疾病特定存活率,也可能可以减少侵犯性治疗的需要。
  
  他们指出,这篇不是随机控制试验,也不是评估筛检计画,因而限缩了提出建议的能力。
  
  最近几年,使用乳房X光摄影对年长妇女进行筛检一直是个热门的争论议题。
  
  2009年,美国预防服务工作小组结论指出,证据不足以衡量乳房X光摄影用于75岁以上妇女的效益或伤害。
  
  不过,美国癌症协会建议,只要这些妇女没有严重慢性病或寿命缩短,都可对她们进行检查。
  
  Malmgren医师等人观察发现,在筛检有效性研究中并没有75岁以上妇女。
  
  Malmgren医师在媒体声明中表示,缺乏研究导致无法提出建议,她解释,没有研究探讨75岁以上妇女,即便她们的乳癌风险确实比较高。
  
  为了改善这个状况,研究团队回顾了1990-2011年间、各机构的乳癌登记资料库,确认有1,162名妇女被诊断有第0-IV期乳癌时的年龄至少75岁。
  
  这21年期间,64%(744/1162)的乳癌(包括导管原位癌)是以乳房X光摄影诊断,36% (418/1162)是由病患或病患的医师发现;平均追踪期间是7.3年;乳房X光摄影发现的病灶大部份是第I期(62%),而病患或医师发现的大部份是第II或第III期(59%)。
  
  侵犯性乳癌的5年疾病特定存活方面,藉由乳房X光摄影发现者显著优于病患或医师发现者(97% vs 87%;P< .001)。研究者解释,乳房X光摄影发现组的存活率较优可能是较少后期乳癌者。
  
  此外,相较于由病患或医师发现者,乳房X光摄影发现之侵犯性乳癌的治疗比较可能包括乳房肿瘤切除术和放射,且乳房X光摄影发现的病患比较少转移和化疗(P< .001)。
  
  Malmgren医师等人强调这年龄层患者发现的乳癌分期越早期越好的重要性,他们写道,早期病灶可能不用化疗即可治癒。对这些接受此类治疗的年长妇女而言,因为共病症比率较高且一般缺乏弹性,最好是避免化疗。
  
  他们指出,因为这些年长妇女可能比较长寿,需考虑乳癌筛检,75岁时,余命估计有13年,80岁时,则是9年。
  
  研究者报告指出,在比较年轻的妇女(50-74岁),随机临床试验显示乳房X光摄影筛检可以侦测比较早期的乳癌,减少乳癌特定死亡率。
  
  他们结论指出,在较年轻妇女发现的乳房X光摄影的好处,或许也可适用于75岁以上妇女。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7105&x_classno=0&x_chkdelpoint=Y
  

Breast Cancer Found by Mammography: Older Women May Benefit

By Nick Mulcahy
Medscape Medical News

UPDATED // Although mammography is often not recommended for women 75 years and older, it might be beneficial for this age group, according to a study published online August 5 in Radiology.

Mammography-detected breast cancer in women 75 years and older has a number of advantages over breast cancer detected by older patients themselves or by their physicians, the researchers report.

Specifically, the machine-detected cancers were diagnosed at an earlier stage, required less treatment, and had better rate of 5-year disease-specific survival.

"Women should be informed of the possible benefit of a decreased need for aggressive treatment and better disease-specific survival with early detection with mammography," write the researchers, led by Judith A. Malmgren, PhD, affiliate assistant professor at the University of Washington School of Public Health and Community Medicine in Seattle.

They note that the study is not a randomized controlled trial or an evaluation of a screening program, "which restricts our ability to make recommendations."

The value of mammography screening in older women has been a hotly debated topic in recent years.

In 2009, the US Preventive Services Task Force concluded that evidence was "insufficient to assess the balance of benefits and harms" of mammography for women 75 years and older.

However, the American Cancer Society recommends screening these older women as long as they have no serious chronic conditions or a shortened life expectancy.

Women 75 years and older are not represented in screening effectiveness studies, Dr. Malmgren and colleagues observe.

A lack of research is chiefly responsible for the divergent recommendations, Dr. Malmgren said in a press statement. "There are no studies on women age 75 and older, despite the fact that they are at the highest risk for breast cancer," she explained.

To rectify the situation, the researcher team reviewed an institutional breast cancer registry database for the period from 1990 to 2011 and identified 1162 women who were at least 75 years of age when they were diagnosed with stage 0 to IV disease.

Over the 21 year-period, 64% (744 of 1162) of the breast cancers (including ductal carcinoma in situ) were diagnosed with mammography and 36% (418 of 1162) were found by either the patient or the patient's physician.

The average follow-up period was 7.3 years.

Most mammography-detected disease was stage I (62%), whereas most patient/physician-detected disease was stage II or III (59%).

Five-year disease-specific survival for invasive breast cancer was significantly better for mammography-detected disease than for patient/physician-detected disease (97% vs 87%; P < .001). The superior rate of survival is "likely the effect of fewer late-stage cancers," the researchers explain.

In addition, the treatment of invasive breast cancer was more likely to involve lumpectomy and radiation when disease was mammography-detected than when it was patient/physician-detected, and patients with mammography-detected disease underwent fewer mastectomies and less chemotherapy (P < .001).

Dr. Malmgren and colleagues emphasize the importance of the "downstaging" of breast cancer in this older age group. Early-stage lesions are "potentially treatable without chemotherapy," they write. Avoiding chemotherapy is desirable because of "higher rates of comorbidities" and the "general lack of resilience" in older women receiving such toxic treatment.

They note that because these older women can live a long time, breast cancer screening should be considered. At age 75, life expectancy is another 13 years; at age 80, it is another 9 years.

In younger women (50 to 74 years), randomized clinical trials have demonstrated that mammography screening detects breast cancer at an earlier stage and reduces breast-cancer-specific mortality, the researchers report.

They they conclude that the benefits of mammography screening documented in younger women "may apply to women aged 75 years and older."

This study was funded by the Kaplan Cancer Research Fund and was conducted at the Swedish Cancer Institute. The authors have disclosed no relevant financial relationships.

Radiology. Published online August 5, 2014.

    
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