乳房X光攝影發現乳癌:對年長婦女有幫助


  【24drs.com】根據線上發表於8月5日放射學期刊的一篇研究,雖然一般未建議75歲以上婦女進行乳房X光攝影,但對這個年齡層婦女可能是有幫助的。
  
  研究者報告指出,相較於讓這些病患自己或她們的醫師檢測,使用乳房X光攝影偵測75歲以上婦女的乳癌有許多優點;特別要提的是,儀器偵測到的乳癌是比較初期的,所需治療較少,5年疾病特定存活率較佳。
  
  西雅圖華盛頓大學公衛與社區醫學院客座助理教授Judith A. Malmgren博士等研究者寫道,應告訴這些婦女,使用乳房X光攝影檢查可以有比較好的疾病特定存活率,也可能可以減少侵犯性治療的需要。
  
  他們指出,這篇不是隨機控制試驗,也不是評估篩檢計畫,因而限縮了提出建議的能力。
  
  最近幾年,使用乳房X光攝影對年長婦女進行篩檢一直是個熱門的爭論議題。
  
  2009年,美國預防服務工作小組結論指出,證據不足以衡量乳房X光攝影用於75歲以上婦女的效益或傷害。
  
  不過,美國癌症協會建議,只要這些婦女沒有嚴重慢性病或壽命縮短,都可對她們進行檢查。
  
  Malmgren醫師等人觀察發現,在篩檢有效性研究中並沒有75歲以上婦女。
  
  Malmgren醫師在媒體聲明中表示,缺乏研究導致無法提出建議,她解釋,沒有研究探討75歲以上婦女,即便她們的乳癌風險確實比較高。
  
  為了改善這個狀況,研究團隊回顧了1990-2011年間、各機構的乳癌登記資料庫,確認有1,162名婦女被診斷有第0-IV期乳癌時的年齡至少75歲。
  
  這21年期間,64%(744/1162)的乳癌(包括導管原位癌)是以乳房X光攝影診斷,36% (418/1162)是由病患或病患的醫師發現;平均追蹤期間是7.3年;乳房X光攝影發現的病灶大部份是第I期(62%),而病患或醫師發現的大部份是第II或第III期(59%)。
  
  侵犯性乳癌的5年疾病特定存活方面,藉由乳房X光攝影發現者顯著優於病患或醫師發現者(97% vs 87%;P< .001)。研究者解釋,乳房X光攝影發現組的存活率較優可能是較少後期乳癌者。
  
  此外,相較於由病患或醫師發現者,乳房X光攝影發現之侵犯性乳癌的治療比較可能包括乳房腫瘤切除術和放射,且乳房X光攝影發現的病患比較少轉移和化療(P< .001)。
  
  Malmgren醫師等人強調這年齡層患者發現的乳癌分期越早期越好的重要性,他們寫道,早期病灶可能不用化療即可治癒。對這些接受此類治療的年長婦女而言,因為共病症比率較高且一般缺乏彈性,最好是避免化療。
  
  他們指出,因為這些年長婦女可能比較長壽,需考慮乳癌篩檢,75歲時,餘命估計有13年,80歲時,則是9年。
  
  研究者報告指出,在比較年輕的婦女(50-74歲),隨機臨床試驗顯示乳房X光攝影篩檢可以偵測比較早期的乳癌,減少乳癌特定死亡率。
  
  他們結論指出,在較年輕婦女發現的乳房X光攝影的好處,或許也可適用於75歲以上婦女。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7105&x_classno=0&x_chkdelpoint=Y
  

Breast Cancer Found by Mammography: Older Women May Benefit

By Nick Mulcahy
Medscape Medical News

UPDATED // Although mammography is often not recommended for women 75 years and older, it might be beneficial for this age group, according to a study published online August 5 in Radiology.

Mammography-detected breast cancer in women 75 years and older has a number of advantages over breast cancer detected by older patients themselves or by their physicians, the researchers report.

Specifically, the machine-detected cancers were diagnosed at an earlier stage, required less treatment, and had better rate of 5-year disease-specific survival.

"Women should be informed of the possible benefit of a decreased need for aggressive treatment and better disease-specific survival with early detection with mammography," write the researchers, led by Judith A. Malmgren, PhD, affiliate assistant professor at the University of Washington School of Public Health and Community Medicine in Seattle.

They note that the study is not a randomized controlled trial or an evaluation of a screening program, "which restricts our ability to make recommendations."

The value of mammography screening in older women has been a hotly debated topic in recent years.

In 2009, the US Preventive Services Task Force concluded that evidence was "insufficient to assess the balance of benefits and harms" of mammography for women 75 years and older.

However, the American Cancer Society recommends screening these older women as long as they have no serious chronic conditions or a shortened life expectancy.

Women 75 years and older are not represented in screening effectiveness studies, Dr. Malmgren and colleagues observe.

A lack of research is chiefly responsible for the divergent recommendations, Dr. Malmgren said in a press statement. "There are no studies on women age 75 and older, despite the fact that they are at the highest risk for breast cancer," she explained.

To rectify the situation, the researcher team reviewed an institutional breast cancer registry database for the period from 1990 to 2011 and identified 1162 women who were at least 75 years of age when they were diagnosed with stage 0 to IV disease.

Over the 21 year-period, 64% (744 of 1162) of the breast cancers (including ductal carcinoma in situ) were diagnosed with mammography and 36% (418 of 1162) were found by either the patient or the patient's physician.

The average follow-up period was 7.3 years.

Most mammography-detected disease was stage I (62%), whereas most patient/physician-detected disease was stage II or III (59%).

Five-year disease-specific survival for invasive breast cancer was significantly better for mammography-detected disease than for patient/physician-detected disease (97% vs 87%; P < .001). The superior rate of survival is "likely the effect of fewer late-stage cancers," the researchers explain.

In addition, the treatment of invasive breast cancer was more likely to involve lumpectomy and radiation when disease was mammography-detected than when it was patient/physician-detected, and patients with mammography-detected disease underwent fewer mastectomies and less chemotherapy (P < .001).

Dr. Malmgren and colleagues emphasize the importance of the "downstaging" of breast cancer in this older age group. Early-stage lesions are "potentially treatable without chemotherapy," they write. Avoiding chemotherapy is desirable because of "higher rates of comorbidities" and the "general lack of resilience" in older women receiving such toxic treatment.

They note that because these older women can live a long time, breast cancer screening should be considered. At age 75, life expectancy is another 13 years; at age 80, it is another 9 years.

In younger women (50 to 74 years), randomized clinical trials have demonstrated that mammography screening detects breast cancer at an earlier stage and reduces breast-cancer-specific mortality, the researchers report.

They they conclude that the benefits of mammography screening documented in younger women "may apply to women aged 75 years and older."

This study was funded by the Kaplan Cancer Research Fund and was conducted at the Swedish Cancer Institute. The authors have disclosed no relevant financial relationships.

Radiology. Published online August 5, 2014.

    
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