中国乳腺癌筛查模式探讨

摘要

乳腺X线(钼靶)筛查乳腺癌虽然在西方国家取得病死率逐年下降的实效,但是目前不断有证据质疑乳腺癌筛查的综合收益,包括钼靶检查造成的放射线损害和重复钼靶检查以及活检等造成的过度诊断问题.此外,筛查模式的不同(包括不同的筛查人群、不同的筛查方法,以及不同的筛查间隔)所造成的筛查综合收益评价的差异,同样也是引起乳腺癌筛查争议的重要原因之一.为此本文阐述导致上述争议的主要原因,同时在合理评定筛查综合收益的基础上,进一步提出改善乳腺癌筛查综合收益的可能途径.为了探寻适合中国国情的乳腺癌筛查模式,决策者应综合考虑优化筛查人群、完善筛查技术、体现知情同意及探索个体化筛查模式4个方面问题.%Cancer screening has been considered as double-edged sword with both advantages and disadvantages.For decades,there have been strong interests in screening strategies for the early detection of cancers to reduce the mortality,especially breast X-ray (mammography) screening.However,several evidences also suggested that the benefit of reduction of breast-cancer mortality with mammography might become a problem due to the repeat mammography,subsequent biopsies,and overdiagnosis.And different screening strategies with different models,different intervals,and different target populations also incurred debates.After systematical analysis and discussion,we suggested to focus on high-risk population,improve the accuracy of screening technique,conduct the informed consent of participants,and explore individual screening mode in the screening of breast cancer.