ADVANCED BREAST-CANCER AND ITS PREVENTION BY SCREENING
ADVANCED BREAST-CANCER AND ITS PREVENTION BY SCREENING
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DOI：
10.1038/bjc.1992.199
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发表时间：
1992-06-01
影响因子：
8.8
通讯作者：
van der Maas, PJ
中科院分区：
文献类型：
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作者：
DEKONING, HJ;VANINEVELD, BM;van der Maas, PJ
在有关乳腺癌筛查的讨论中，许多注意力集中在筛查可能产生的发病率上。预防晚期疾病等有利作用似乎被低估了，可能是因为量化太难了。为了分析对晚期乳腺癌妇女的护理和治疗量，我们报告了从首次复发到死亡的患者，使用患者档案和国家来源。从两个癌症中心的计算机化登记处随机抽取了60例女性病例，从非计算机化的医院登记处随机抽取了20例病例。总共有68份患者档案得到了充分的记录。据估计，与健康女性相比，晚期乳腺癌女性的效用损失39%(范围为27-45%)。14个月内以激素治疗为主，4个月内以化疗为主。从晚期疾病诊断到死亡的总医疗费用为17,100美元，如果包括外部费用，则为21,000美元。对乳腺癌筛查预防晚期疾病发生的效果进行了量化。由此带来的生活质量的提高贡献了生活质量总增长的70%。从长远来看，每年筛查费用的近一半将被晚期疾病费用的节省所抵消。只有姑息手术和/或放射治疗的变化与主要治疗的变化相比是很小的。除了死亡率的降低，筛查还因为生活质量的提高和防止妇女患上晚期疾病而节省了成本。
In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources. A random sample of 60 female cases from computerised registries of two cancer centres and a sample of 20 cases from a non-computerised hospital registry was taken. A total of 68 patient files were sufficiently documented. A woman with advanced breast cancer is estimated to have a 39% loss in utility compared to a healthy woman (range 27-45%). Hormonal treatment is the main modality during 14 and chemotherapy during 4 months. Total medical cost from diagnosis of advanced disease until death amounts to 17,100 US dollars, or 21,000 when including extramural cost.The effect of breast cancer screening by preventing the occurrence of advanced disease is quantified. The resulting gain in quality of life contributes 70% of the total gain in quality of life. In the long run, almost half of the annual cost of screening will be offset by savings in the cost for advanced disease. Only the changes in palliative surgery and/or radiotherapy will be small in contrast to primary treatment changes. Besides the mortality reduction, screening is justified by the improvements in quality of life and cost savings for women prevented from reaching advanced disease.