Developing Technologies for Early Detection of Breast Cancer
Developing Technologies for Early Detection of Breast Cancer
复制标题
开发乳腺癌早期检测技术
DOI：
10.17226/10011
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
L. Newman
中科院分区：
文献类型：
--
作者：
L. Newman
B 型乳腺癌在美国造成了巨大的损失。每年有超过 180,000 例新诊断的浸润性乳腺癌病例，超过 40,000 名女性死于该病。在研究发现一种预防乳腺癌或治愈所有女性（无论其肿瘤何时发现）的方法之前，早期检测将被视为减轻这种疾病负担的最佳希望。希望通过筛查早期发现乳腺癌能够像用于宫颈癌筛查的巴氏涂片一样有效地挽救生命。临床试验表明，X 射线乳房X 光检查可以减少乳腺癌死亡率。然而，乳房X光检查并不完美。临床试验中的常规筛查使 50 至 70 岁女性的乳腺癌死亡率降低了 25-30%。40-49 岁女性的获益较小。由于缺乏数据，70 岁以上女性进行乳房 X 光检查的好处更难以评估。筛查性乳房X光检查不能消除所有乳腺癌死亡，因为它不能检测到所有癌症。有些肿瘤也可能发展得太快，无法使用标准筛查间隔在最可治疗的阶段进行识别。此外，持续生成高质量的乳房 X 光照片在技术上很困难，而且解释也很主观。乳房X光检查也可能对一些女性产生有害影响，表现为假阳性结果以及过度诊断和过度治疗。由于乳房 X 光检查的可疑发现而进行活检的所有乳房病变中，多达四分之三的病变被证明是良性的，即乳房 X 光检查结果呈假阳性。 “过度诊断”是将小病变标记为癌症或癌前病变，而实际上，如果不及时发现和治疗，这些病变可能永远不会发展为危及生命的疾病。在这种情况下，早期检测后的一些“治愈”可能并不真实，因此这些女性会受到不必要的“过度治疗”。乳腺成像技术的进步使得这些微小异常的识别率有所提高，例如原位癌，其生物学特性尚不清楚。目前，对乳房X光检查检测到的此类病变进行分类的方法是基于组织结构的，并且确定乳房异常的致死潜力的能力充其量是粗略的。乳腺癌的巨大负担和乳房X光检查的固有局限性一直是开发乳腺癌早期检测技术的推动力。美国国家科学院的下属机构美国医学研究所 (IOM) 发布了一份名为《乳房 X 光检查及其在乳腺癌筛查中的应用》的报告，临床试验表明 X 射线乳房 X 光检查可以减少乳腺癌死亡率。
B reast cancer takes a tremendous toll in the United States. Each year, over 180,000 new cases of invasive breast cancer are diagnosed, and more than 40,000 women die from the disease. Until research uncovers a way to prevent breast cancer or to cure all women regardless of when their tumors are found, early detection will be looked upon as the best hope for reducing the burden of this disease. The hope is that early detection of breast cancer by screening could be as effective in saving lives as the Papanicolau smear used for cervical cancer screening. X-ray mammography has been shown in clinical trials to reduce breast cancer deaths. However, mammography is not perfect. Routine screening in clinical trials resulted in a 25–30% decrease in breast cancer mortality among women between the ages of 50 and 70. A lesser benefit was seen among women aged 40–49. The benefit of screening mammography for women over 70 was more difficult to as sess due to a lack of data. Screening mammography cannot eliminate all breast cancer deaths because it does not detect all cancers. Some tumors may also develop too quickly to be identified at the most treatable stage using the standard screening intervals. Fur thermore, it is technically difficult to consistently produce mammograms of high quality and interpretation is subjective. Mammography can also have deleterious effects for some women, in the form of false positive results and overdiagnosis and overtreatment. As many as threequarters of all breast lesions biopsied because of suspicious findings on a mam mogram turn out to be benign, i.e., the mammographic findings were falsely posi tive. “Overdiagnosis” is the labeling of small lesions as cancer or precancer when in fact the lesions may never have progressed to a life-threatening disease if left undetected and untreated. In such cases, some of the “cures” following early de tection may not be real, and thus such women are unnecessarily “overtreated.” Technical improvements in breast imaging techniques have led to an increase in the identification of these small abnormalities, such as carcinoma in situ, whose biology is not well understood. Currently, methods for classifying such lesions detected by mammography are based on tissue structure, and the ability to determine the lethal potential of breast abnormalities is crude at best. The immense burden of breast cancer and the inherent limitations of mam mography have been the driving forces behind efforts to develop technologies for the early detection of breast cancer. The Institute of Medicine (IOM), an arm of the National Academies, released a report called Mammography and Beyond in Breast cancer screen ing by X-ray mammog raphy has been shown in clinical trials to re duce breast cancer deaths.