Contribution of clinical breast examination to mammography screening in the early detection of breast cancer
Contribution of clinical breast examination to mammography screening in the early detection of breast cancer
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DOI：
10.1258/096914103321610761
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发表时间：
2003-01-01
影响因子：
2.9
通讯作者：
Brisson, J
中科院分区：
文献类型：
--
作者：
Bancej, C;Decker, K;Brisson, J
目的：由于临床乳房检查(CBE)在降低乳腺癌死亡率方面相对于单纯筛查乳房X光检查的益处尚不确定，因此监测其对筛查计划有效性的临时措施的贡献是有意义的。方法：对1996-1998年间接受双重筛查(CBE和钼靶摄影)的妇女(n=300,303)在筛查和诊断之间的随访。通过检测模式评估的结果(单独的CBE，单独的乳房X光检查，或CBE和乳房X光检查两者)包括转诊。总的和小的癌症(小于或等于10 mm或结节阴性)的发现率、阳性预测值、肿瘤的病理特征(大小、结节状态、形态)和癌症的发现率。结果：在第一次筛查和随后的筛查中，仅CBE就导致了28.5%-36.7%的转介和4.6%-5.9%的癌症，而单独进行乳房X光检查的转介和癌症的转介比例为52.6-60.1%，癌症的转介比例为60.0-64.3%。在CBE发现的癌症中，83.6-88.6%的癌症也是通过乳房X光检查发现的，而对于乳房X光检查发现的癌症，只有31.7-37.2%的癌症是通过乳房X光检查发现的。CBE。平均而言，如果乳房X光检查是唯一的检测方法，CBE将小浸润性癌症的检测率提高了2-6%。如果没有CBE，每10,000个筛查就会漏掉3个癌症，每100,000个筛查中会漏掉3-10个小的浸润性癌症。结论：将CBE纳入有组织的项目对早期发现的贡献最小。
Objectives: As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated.Setting: Four Canadian organised breast cancer screening programmes.Methods: Women aged 50-69 receiving dual screening (CBE and mammography) (n = 300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral. rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (less than or equal to 10 mm or node-negative). Heterogeneity in findings across programmes was also assessed.Results: On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by. CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens.Conclusions: Inclusion of CBE in an organised programme contributes minimally to early detection.