Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.
Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.
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DOI：
10.1001/jama.2015.12783
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发表时间：
2015-10-20
期刊：
影响因子：
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通讯作者：
American Cancer Society
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文献类型：
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作者：
Oeffinger KC;Fontham ET;Etzioni R;Herzig A;Michaelson JS;Shih YC;Walter LC;Church TR;Flowers CR;LaMonte SJ;Wolf AM;DeSantis C;Lortet-Tieulent J;Andrews K;Manassaram-Baptiste D;Saslow D;Smith RA;Brawley OW;Wender R;American Cancer Society
乳腺癌是美国妇女过早死亡的主要原因。早期发现已被证明与降低乳腺癌发病率和死亡率有关。这份报告更新了美国癌症协会（ACS）2003年乳腺癌筛查指南，针对平均乳腺癌风险的女性。ACS委托对乳腺癌筛查文献进行系统性证据综述，以告知更新情况，并对乳腺X线摄影登记数据进行补充分析，以解决与筛查间隔相关的问题。建议的制定是基于证据的质量和关于利益和危害平衡的判断（包括价值观和偏好）。在一系列研究设计中，40-69岁女性的乳腺X线筛查与乳腺癌死亡率降低相关，推理证据支持70岁及以上健康状况良好的女性进行乳腺癌筛查。由于乳房X线照片的数量更多，以及年轻女性的回忆率更高，如果筛查在年轻时开始，则假阳性检查的累积终身风险估计更大。过度诊断证据的质量不足以有信心地估计终身风险。检查筛查间隔的分析表明，绝经前妇女每年筛查一次比每两年筛查一次更有利的肿瘤特征。没有证据支持常规临床乳房检查作为一般风险妇女的筛查方法。ACS建议，具有平均乳腺癌风险的女性应该从45岁开始定期进行乳房X光检查（强烈建议）。年龄在45至54岁之间的女性应每年进行筛查（合格建议）。年龄在55岁及以上的女性应该过渡到两年一次的筛查，或者有机会每年继续筛查（合格的建议）。女性应该有机会在40至44岁之间开始年度筛查（合格建议）。妇女应继续筛查乳房X光检查，只要他们的整体健康状况良好，他们有10年或更长的预期寿命（合格的建议）。ACS不建议在任何年龄的平均风险女性中进行乳腺癌筛查的临床乳房检查（合格建议）。
Breast cancer is a leading cause of premature mortality among U.S. women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. This report updates the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update, and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. Mammography screening in women aged 40–69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening in women who are age 70 years and older and are in good health. Estimates of the cumulative lifetime risk of false positive exams are greater if screening begins at younger ages due to the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs. biennially. Evidence does not support routine clinical breast examination as a screening method for average risk women. The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women who are ages 45 to 54 years should be screened annually (qualified recommendation). Women who are age 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).