Regular self-examination or clinical examination for early detection of breast cancer.
Regular self-examination or clinical examination for early detection of breast cancer.
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DOI：
10.1002/14651858.cd003373
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发表时间：
2003-01-01
期刊：
影响因子：
--
通讯作者：
Gotzsche, P C
中科院分区：
文献类型：
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作者：
Kosters, J P;Gotzsche, P C
背景技术背景：多年来，乳房自我检查和临床乳房检查一直被推广为早期诊断乳腺癌的一般筛查方法，以降低发病率和/或死亡率。可能的好处和危害仍然不清楚。结论：为了确定是否筛查乳腺癌定期自我检查或临床乳腺检查降低乳腺癌的死亡率和发病率。检索由科克伦乳腺癌组维护的专业登记册。选择标准：随机临床试验，包括群集随机试验。数据收集和分析：决定哪些试验包括由审查员根据试验方法独立进行。通过讨论解决了分歧。意向治疗分析采用固定效应模型与95%的置信区间进行。主要结果：两个大的人口为基础的研究（388,535名妇女），从俄罗斯和上海，比较乳房自我检查，没有干预。乳腺癌死亡率无统计学显著差异，相对危险度为1.05（95%置信区间（CI）0.90 - 1.24）（共587例死亡）。在俄罗斯，乳房自我检查组比对照组发现更多的癌症（相对风险1.24，95%CI 1.09至1.41），而在上海则不是这样（相对风险0.97，95%CI 0.88至1.06）。与对照组（1856例）相比，筛查组（3406例）进行了几乎两倍于对照组（1856例）的良性活检，相对危险度为1.89，95%CI为1.79 - 2.00。审查者结论：两项大型试验的数据并未表明乳房自我检查筛查的有益效果，但有证据表明其有害。没有临床乳腺检查的随机试验。目前，不建议进行乳房自检。
BACKGROUND: Breast self-examination and clinical breast examination have been promoted for many years as general screening methods to diagnose breast cancer at an earlier stage in order to decrease morbidity and or mortality. The possible benefits and harms remain unclear.OBJECTIVES: To determine whether screening for breast cancer by regular self-examination or clinical breast examination reduces breast cancer mortality and morbidity.SEARCH STRATEGY: The Cochrane Library and Medline were searched for randomised trials; date of last search October 2002. The specialised register maintained by the Cochrane Breast Cancer Group was searched.SELECTION CRITERIA: Randomised clinical trials, including cluster randomised trials.DATA COLLECTION AND ANALYSIS: Decisions on which trials to include were taken independently by the reviewers based on the methods of trial. Disagreements were resolved by discussion. Intention to treat analyses were conducted using a fixed effect model with 95% confidence intervals.MAIN RESULTS: Two large population-based studies (388,535 women) from Russia and Shanghai that compared breast self-examination with no intervention were included. There was no statistically significant difference in breast cancer mortality, relative risk 1.05 (95% confidence interval (CI) 0.90 to 1.24) (587 deaths in total). In Russia, more cancers were found in the breast self-examination group than in the control group (relative risk 1.24, 95% CI 1.09 to 1.41), while this was not the case in Shanghai (relative risk 0.97, 95% CI 0.88 to 1.06). Almost twice as many biopsies (3406) with benign results were performed in the screening group compared to the control group (1856), relative risk 1.89, 95% CI 1.79 to 2.00.REVIEWER'S CONCLUSIONS: Data from two large trials do not suggest a beneficial effect of screening by breast self-examination whereas there is evidence for harms. There were no randomised trials of clinical breast examination. At present, breast self-examination cannot be recommended.