女性乳腺癌筛查: 权威专家剖析四个关键点

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女性乳腺癌筛查: 权威专家剖析四个关键点


原标题:女性乳腺癌筛查: 权威专家剖析四个关键点
美国医师协会(ACP)最新临床指南中,针对无症状、一般风险女性的乳腺癌筛查给出了七项指导原则。乳腺癌权威专家,Dr. Andrew M. Kaunitz为您剖析其中的关键点所在。
Today I return to the persistently emotional topic of breast cancer screening. Recommendations from professional societies about screening in average-risk women vary with respect to starting age, stopping age, frequency of screening, and whether a clinical breast examination should be performed. 
This guidance statement from the American College of Physicians (ACP) assessed seven existing guidelines addressing breast cancer screening in a symptomatic, average-risk women.
Here are the ACP's four principal recommendations:
For women aged 40-49 years, clinicians should review pros and consof mammography, taking into account a woman's preferences. The ACP cautioned that for most women in this age group, harms from screening out weigh the benefits.
For women aged 50-74 years, clinicians should offer biennial mammograms.
Women aged 75 yearrs or older or those with a life expectancy of 10 years or less should discontinue screening.
Regardless of age, screening clinical breast examinations are not recommended.
The ACP noted that, overall, the magnitude of reduction of breast cancer mortality associated with mammography is small, a point they felt that most guidelines did not emphasize. In addition, looking at all age groups, mammography was not found to reduce all-cause mortality.
While mammography was consistently found to reduce breast cancer mortality in women aged 50-69 years, most reviewed studies failed to demonstrate a similar reduction among younger women.
All reviewed evidence found that women aged 39-49 years received the least benefit from screening with respect to deaths prevented. 
In addition, screening in this age group was not found to reduce the incidence of advanced breast cancer. 
In these younger women, the harms, including over-diagnosis, over-treatment, false-positive results, and unnecessary diagnostic testing  (as well as biopsies) out weighed the benefits of screening.
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