Is there a downside to elderly women undergoing screening mammography?
Is there a downside to elderly women undergoing screening mammography?
复制标题
老年女性接受乳房X光检查有什么缺点吗？
DOI：
10.1093/jnci/90.18.1322
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Kerlikowske,K
中科院分区：
文献类型：
--
作者：
Smith-Bindman,R;Kerlikowske,K
It has been more than 10 years since the initial report of an association between amplification of erbB-2 (also known as HER-2/neu and ERBB2) and poor clinical outcome of patients with primary breast cancer (1). Dozens of papers involving thousands of patients have now been published on this topic, and the general conclusion is that erbB-2 abnormalities, either gene amplification or protein overexpression, are associated with worse prognosis of patients with lymph node-positive breast cancer, but the relationship for patients with lymph node-negative disease is weak, at best. Since most of these correlative studies were retrospective and many of the patients were treated before adjuvant therapy was widely administered to patients with lymph node-negative disease, several clinical researchers speculated that these associations were due, in part, to specific adjuvant therapies received by lymph node-positive patients. The first studies that examined the potential role of erbB-2 status for predicting response to adjuvant chemotherapy concentrated on regimens that contained CMF (cyclophosphamide, methotrexate, and 5-fluorouracil)(2, 3). The general trend reported in these and subsequent studies is that patients whose tumors have little or no detectable levels of erbB-2 derive considerable benefit from CMF regimens, but patients whose tumors have amplified erbB-2 genes or overexpress erbB-2 protein do not benefit from these therapies. However, it must be stressed that these conclusions are based on retrospective analyses, and they have not been validated in prospective studies with sufficient statistical power to detect interactions between treatment and erbB-2 status.In 1994, Muss et al.(4) published, to our knowledge, the first analysis of an interaction between expression of erbB-2 and adjuvant therapy with doxorubicin-containing regimens. The finding that tumors with high expression of erbB-2 responded better to dose-intensive treatment with CAF (cyclophosphamide, doxorubicin [Adriamycin], and 5-fluorouracil) was contrary to the previous results with the CMF regimens and spurred international efforts to validate or refute the published data and to understand the biologic mechanisms that might explain such results. But such validation studies are difficult to perform, and analyses of interactions between treatments and potential predictive factors can be accomplished only within a randomized clinical trial. Without the protection of randomization, selection biases will result in confounding effects between treatments administered and potential predictive factors that cannot be overcome with the most sophisticated multivariate statistical analyses.
