Table CDR62751 Breast Cancer Screening/乳腺癌筛查
ID Type Description_en Description_zh
w1 Word Anxiety ​焦虑
w2 Word Race 种族
w3 Word Men 男性
w4 Word Discomfort ​不适感
w5 Word Sensitivity 敏感性
w6 Word Thermography ​热像图
w7 Word Benefits ​获益
w8 Word Bias 偏倚
w9 Word Harms ​危害
w10 Word Overdiagnosis ​过度诊断
w11 Word Ultrasonography ​超声检查
w12 Word Background ​背景
w13 Word Analysis: Follow-up 分析方法:随访分析法
w14 Word Special Populations 特殊人群
w15 Word Elderly women 老年女性
w16 Word Breast Self-examination ​乳腺自我检查
w17 Word Contamination: None 干扰:无
w18 Word Interval cancers 间期癌
w19 Word Facility Characteristics 机构特征
w20 Word Radiation Exposure ​射线暴露
w21 Word Analysis: Evaluation 分析方法:评估分析法
w22 Word International Comparisons ​国家对比
w23 Word Tumor Characteristics ​肿瘤特征
w24 Word Young women 年轻女性
w25 Word Patient Characteristics 患者特征
w26 Word Physician Characteristics 医师特征
w27 Word Digital Mammography 数字乳腺X线摄影
p1 Phrase Mammography and CAD 乳腺X线摄影及CAD
p2 Phrase Magnetic Resonance Imaging ​磁共振成像
p3 Phrase Compliance: 89% participation 依从性:参与度89%
p4 Phrase Control: Usual care 对照组:常规护理
p5 Phrase External audit: None 外部审核:无
p6 Phrase Screening With Mammography 乳腺X线摄影筛查
p7 Phrase Compliance: 61% screened 依从性:61%的受试者完成了筛查
p8 Phrase Compliance: 89% screened 依从性:89%的受试者完成了筛查
p9 Phrase Randomized controlled trials 随机对照临床试验
p10 Phrase Compliance: 82% screened 依从性:82%的受试者完成了筛查
p11 Phrase Consistency : Fair ​一致性: 一般
p12 Phrase Summary of RCTs RCT总结
p13 Phrase Dense breast tissue 乳腺组织致密
p14 Phrase External audit: No 外部审核:无
p15 Phrase Prior radiation therapy 既往放疗史
p16 Phrase Clinical Breast Examination ​临床乳腺检查
p17 Phrase Benefit of Mammography 乳腺X线摄影的益处
p18 Phrase BCSC Web site BCSC 网站
p19 Phrase Control: Annual CBE 对照组:每年进行一次CBE
p20 Phrase Exclusions: Inconsistently reported 排除:各项报告排除例数不一致
p21 Phrase External audit: Yes 外部稽查:有
p22 Phrase Mammography—Variables Associated with Accuracy 乳腺X线摄影——影响准确性的变量
p23 Phrase Follow-up duration: 12 years 随访时间:12年
p24 Phrase External Validity : Poor ​外部效度:较差
p25 Phrase Follow-up duration: 8 years 随访时间:8年
p26 Phrase Breast Cancer Screening Modalities—Mammography 乳腺癌筛查方法——乳腺X线摄影
p27 Phrase Consistency of reports: Good 报告的一致性:佳
p28 Phrase Ductal Carcinoma In Situ ​导管内原位癌
p29 Phrase Consistency of reports: Variable 报告的一致性:多样
p30 Phrase Current Age (in Years) 目前年龄(岁)
p31 Phrase Follow-up duration: 18 years 随访时间:18年
p32 Phrase Evaluation of Breast Symptoms ​乳房症状评估
p33 Phrase Breast Cancer (PDQ®): Screening 乳腺癌(PDQ®):筛查​
p34 Phrase Breast Cancer Surveillance Consortium 乳腺癌监管联合会
p35 Phrase Specificity and false-positive rate 特异性和假阳性率
p36 Phrase Description of the Evidence ​证据描述
p37 Phrase Breast Cancer Screening Concepts 乳腺癌的筛查概念
p38 Phrase Internal Validity : Good ​内部效度: 佳
p39 Phrase Follow-up duration: 10 years 随访时间:10年
p40 Phrase Mammography Description and Background 乳腺X线摄影的描述及背景
p41 Phrase Follow-up duration: 13 years 随访时间:13年
p42 Phrase Harms of Screening Mammography 乳腺X线摄影筛查的危害
p43 Phrase Follow-up duration: 10.7 years 随访时间:10.7年
p44 Phrase Personal history of breast cancer 既往乳腺癌病史
p45 Phrase Comments: Randomization process was flawed 评论:随机分组过程存在瑕疵
p46 Phrase Breast cancer incidence and mortality ​乳腺癌的发病率和死亡率
p47 Phrase Seventeen studies met inclusion criteria 共有17项研究满足入选标准
p48 Phrase Appendix of Randomized Controlled Trials 附录:随机对照试验
p49 Phrase Exclusions: Few, balanced between groups 排除:很少,各组间保持平衡
p50 Phrase Effectiveness of Population-Based Screening Programs 基于人群的筛查项目的有效性
p51 Phrase Randomization: Individual volunteer (see NBSS-1) 随机分组:个体随机分组(见前述NBSS-1)
p52 Phrase Breast Cancer Screening Modalities—Beyond Mammography 乳腺癌筛查方法——除乳腺X线摄影之外的其他方法
p53 Phrase Follow-up duration: 12 to14 years 随访时间:12到14年
p54 Phrase Women with limited life expectancy 预期寿命有限的女性
p55 Phrase Study design : Descriptive population-based 研究设计: 基于人群的描述性研究
p56 Phrase Adapted from Altekruse et al 改编自Altekruse et al.
p57 Phrase Breast Cancer Diagnosis and Pathology 乳腺癌的诊断和病理学
p58 Phrase Assessment of Performance and Accuracy 有效性及准确度的评估
p59 Phrase Risk Factors for Breast Cancer ​乳腺癌的危险因素
p60 Phrase Risk in Next 10 Years 未来10年内的风险
p61 Phrase Study Design : Two RCTs ​研究设计: 两项RCT
p62 Phrase Pathologic Diagnosis of Breast Cancer ​乳腺癌的病理诊断
p63 Phrase Breast Cancer Treatment and Pregnancy 乳腺癌的治疗与妊娠
p64 Phrase Randomization: Cluster by birth date 随机分组:根据出生日期分组
p65 Phrase Control: MMG at year 5 对照组:第5年进行一次MMG
p66 Phrase Consistency of reports: Not applicable 报告的一致性:不适用
p67 Phrase Medullary carcinomas may be similarly missed 髓样癌出于同样的原因也可能会被漏诊
p68 Phrase Magnitude of Effect : No effect ​效应强度: 无效
p69 Phrase Consistency and External Validity : Poor ​一致性和外部效度:较差
p70 Phrase Single-read first three rounds, then double-read 前三次筛查仅单次阅片,之后为双重阅片
p71 Phrase Women who have received thoracic radiation 既往接受过胸部放疗的女性
p72 Phrase False-Positives Leading to Possible Additional Interventions ​假阳性导致额外干预
p73 Phrase Other research on BSE is limited 其他关于BSE的研究十分有限
p74 Phrase Internal Validity and Consistency : Fair 内部效度和一致性: 一般
p75 Phrase Contamination: 26.4% in usual care group 干扰:常规护理组26.4%出现了干扰
p76 Phrase Such results have not been observed 然而这样的结果并未出现
p77 Phrase Intervention: Annual two-view MMG and CBE 试验组:每年进行双视图MMG和CBE
p78 Phrase Several CAD systems are in use 目前已有部分CAD系统正在应用之中
p79 Phrase Positioning of the woman is important 女性在检查中的体位亦十分重要
p80 Phrase Analysis: Both evaluation and follow-up methods 分析方法:联合评估和随访分析法
p81 Phrase Age at entry: 45 to 64 years 入组年龄:45到64岁
p82 Phrase Contamination: 16.9% of the CBE only group 干扰:单独CBE筛查组16.9%出现了干扰
p83 Phrase The Swedish meta-analysis resolved these questions appropriately 瑞典荟萃分析适当地解决了这些问题
p84 Phrase Breast Cancer Surveillance Consortium (BCSC) Web site 乳腺癌监管联合会(BSCS)网站
p85 Phrase Age at entry: 39 to 59 years 入组年龄:39到59岁
p86 Phrase Lifetime Risk of a Breast Cancer Diagnosis 乳腺癌诊断的终生风险
p87 Phrase Age at entry: 50 to 59 years 入组年龄:50到59岁
p88 Phrase Age at entry: 45 to 69 years 入组年龄:45到69岁
p89 Phrase Age at entry: 40 to 64 years 入组年龄:40到64岁
p90 Phrase Sample size: 23,226 study and 21,904 control 样本量:试验组和对照组分别有23,226例和21,904例受试者
p91 Phrase Age at entry: 39 to 41 years 入组年龄:39到41岁
p92 Phrase Sample size: 21,088 study and 21,195 control 样本量:试验组和对照组分别为21,088例和21,195例受试者
p93 Phrase Study Design : Two RCTs, cohort studies ​研究设计:两项RCT及队列研究
p94 Phrase Linked to Swedish Cause of Death Registry 研究数据连接瑞典死亡原因登记处
p95 Phrase Characteristics of Cancers Detected by Screening Mammography 经乳腺X线摄影筛查检出肿瘤的特性
p96 Phrase Other risk factors and risk prediction models 其他危险因素和风险预测模型
p97 Phrase Age at entry: 40 to 74 years 入组年龄:40到74岁
p98 Phrase DCIS is most often diagnosed by mammography DCIS最常通过乳腺X线摄影诊断
p99 Phrase Mammography screening rates, however, were generally low 但研究中,使用乳腺X线摄影进行筛查的比例较低
p100 Phrase Treatment of these cancers would constitute overtreatment 对这些肿瘤进行治疗将会导致过度治疗
p101 Phrase Table 1. Risk of Breast Cancer Diagnosis 表1. 乳腺癌的诊断风险
p102 Phrase One Sv is equivalent to 200 mammograms 1 Sv的辐射剂量相当于进行200次乳腺X线摄影
p103 Phrase Age at entry: 40 to 49 years 入组年龄:40到49岁
p104 Phrase Cause of death attribution: Cancer Registry Data 死亡原因分析:癌症登记数据
p105 Phrase Individuals With Little to Gain from Screening 筛查获益很小的人群
s1 Sentence Follow-up analysis as part of the Swedish meta-analysis 瑞典荟萃分析中应用随访分析法
s2 Sentence Consistency of reports: No variation in patient numbers 报告的一致性:患者数量并无差别
s3 Sentence The optimal interval between screening mammograms is unknown 如何确定两次乳腺X线摄影筛查之间的最佳间隔尚有争议
s4 Sentence Neither group received any other breast cancer screening 此外,两组没有接受过其他任何乳腺癌筛查的检查
s5 Sentence Control: Usual care, with MMG at study end 对照组:常规护理,并在研究结束时进行一次MMG
s6 Sentence Independent, with analysis of data by several reviewers 独立稽查,并由审核人员分析数据
s7 Sentence Mammography utilizes ionizing radiation to image breast tissue 乳腺X线摄影利用电离辐射使乳腺组织成像
s8 Sentence Similar studies of Hispanic populations have been conducted 类似的研究亦在西班牙裔人群中开展
s9 Sentence Follow-up analysis, as part of the Swedish meta-analysis 随后作为瑞典荟萃分析的一部分,使用随访分析法
s10 Sentence Overall, only approximately 1% died of breast cancer 总体而言,仅有约1%的病例死于乳腺癌
s11 Sentence Consistency of reports: Variation in sample size reports 报告的一致性:不同报告在样本量上各有差异
s12 Sentence Study Design : Single RCT, population cohort studies ​研究设计: 独立RCT研究,人群队列研究
s13 Sentence Independent with analysis of data by several reviewers 独立稽查,并由审核人员分析数据
s14 Sentence Tissue Sampling (Fine-Needle Aspiration, Nipple Aspirate, Ductal Lavage) 组织活检(细针抽吸活检、乳头抽吸活检、乳管灌洗)
s15 Sentence False-Negatives Leading to Possible False Sense of Security ​假阴性导致错误的安全感
s16 Sentence The process for randomization has not been described 对随机分组的地理集群,研究者比较了基础乳腺癌的发病率和死亡率
s17 Sentence Intervention: Single-view MMG every 28 months × 2 试验组:每隔28个月进行一次单视图MMG,共2次
s18 Sentence The meta-analysis found no other differences by age 荟萃分析未发现其他年龄差异
s19 Sentence Sample size: 160,921 (53,884 invited; 106,956 not invited) 样本量:共160,921例(其中试验组和对照组分别为53,884例和106,956例)
s20 Sentence Approximately 1% of all breast cancers occur in men 乳腺癌中约1%发生于男性
s21 Sentence Thus, the PPV for an abnormal mammogram was 8% 因此通过计算可知,乳腺钼靶检查的结果为异常时,其PPV为8%
s22 Sentence Compliance: Initially 100%, decreased to 85.5% by screen five 依从性:试验初期100%受试者完成了筛查;第五次筛查时该比例降至85.5%
s23 Sentence Sample size: Most recent publication: 21,650 invited; 29,961 control 样本量:最新发表的报告中,试验组和对照组分别有21,650例和29,961例
s24 Sentence Regarding criticisms and comments about this trial, see NBSS-1 其他有关本实验的评论和质疑,见前述NBSS-1
s25 Sentence Screening by CBE may lead to the following harms: ​使用CBE筛查可能会导致以下危害:
s26 Sentence Prevalent Versus Subsequent Examination and the Interval Between Exams ​初次筛查与随访筛查的对比及其筛查间隔
s27 Sentence Follow-up duration: 11 to 16 years (mean 13 years) 随访时间:11-16年(平均13年)
s28 Sentence There is no ionizing radiation exposure with this procedure 这一检查不存在射线暴露
s29 Sentence The optimal screening interval has been addressed by modelers 建模人员给出了最佳筛查间隔
s30 Sentence The incidence of breast cancer increases with a woman's age ​乳腺癌的发病率随着女性年龄的增加而增加
s31 Sentence For women older than 70 years, the PPV was 14% 对于年龄大于70岁的女性而言,这一PPV数值为14%
s32 Sentence Also linked with the Canadian Mortality Data Base, Statistics Canada 数据连接加拿大统计局的加拿大死亡率数据库
s33 Sentence This summary also includes information about screening among special populations 此外,亦包括特殊人群乳腺癌筛查的相关信息
s34 Sentence (Refer to the Cancer Screening Summary Overview for more information.) (更多信息参见肿瘤筛查总论)
s35 Sentence Randomization: Individual volunteers, with names entered successively on allocation lists 随机分组:根据分组列表上的姓名进行个体随机分组
s36 Sentence Abnormal screening may trigger additional testing, with the attendant anxiety 异常的筛查结果可能会导致增加检查,并使患者发生焦虑
s37 Sentence The groups were assembled without obvious bias but without randomization 虽然两组并非随机分组,但参与者无明显偏倚
s38 Sentence Intervention: Two-view MMG every 18 to 24 months × 5 试验组:每隔18到24个月进行一次双视图乳腺X线摄影(MMG),共5次
s39 Sentence Intervention: Annual two-view mammography (MMG) and CBE for 3 years 试验组:每年进行一次双视图乳腺X线摄影(MMG)和CBE,持续3年
s40 Sentence However, these exclusions were determined differently within the two groups 但是,两组如何确定这些应被排除的病例尚有差异
s41 Sentence Intervention: Annual two-view MMG and CBE for 4 to 5 years 试验组:每年进行双视图MMG和CBE,持续4到5年
s42 Sentence Such comparisons may be confounded by social, cultural, and economic factors 这样的对比可能受到社会、文化及经济等多种混杂因素的影响
s43 Sentence Cause of death attribution: Linked to Swedish Cause of Death Registry 死亡原因分析:连接瑞典死亡原因登记处
s44 Sentence These women were dropped from all further consideration in the study 这些受试者一经排除,将不会参与试验的任何后续分析
s45 Sentence Cancer was diagnosed in 6.2%, most often stage II or III 而其中只有6.2%得到肿瘤的诊断,多为II期或III期肿瘤
s46 Sentence Conclusions: Not a statistically significant result, but fits with other studies 结论:试验结果并无统计学意义,但与其他试验结果相符
s47 Sentence Analysis: Evaluation, initially. Follow-up analysis, as part of the Swedish meta-analysis 分析方法:开始使用评估分析法,随后作为瑞典荟萃分析的一部分,使用随访分析法
s48 Sentence Compliance: Participants migrating from Malmo (2% per year) were not followed 依从性:迁离马尔默市的受试者(每年2%)未被随访
s49 Sentence Thus, a negative mammogram should never prevent work-up of breast symptoms 因此,任何女性都不能因为一份阴性的乳腺钼靶筛查报告而停止对乳腺症状的关注和处理
s50 Sentence Most late-stage breast cancer occurs in women not exposed to screening 事实上,大部分晚期乳腺癌肿瘤发生在未进行筛查的女性中
s51 Sentence Cause of death attribution: Determined by a team of local physicians 死亡原因分析:由一组当地的临床医师判定
s52 Sentence The whole-body environmental radiation dose is approximately 3 mSv per year 每年,人体从环境中所接收的辐射剂量约为3 mSv
s53 Sentence Analysis: Evaluation initially, with correction for delay in control group MMG 分析方法:开始使用评估分析法,并对对照组MMG的延迟进行校正
s54 Sentence Cancer was diagnosed in 0.5% of the cases referred for additional testing 上述接受进一步检查的患者中,有0.5%的病例被诊断为乳腺癌
s55 Sentence Some cancers are more easily detected by mammography than other cancers are 某些肿瘤较其他类型相比更容易被乳腺X线摄影检出
s56 Sentence Thus, women who are screened with MRI have more negative surgical biopsies 因此,使用MRI进行筛查的女性进行外科活检,会得到更多阴性结果
s57 Sentence Women younger than 50 years were twice as likely to seek evaluation 而年龄小于50岁的女性寻求医疗评估的可能性是年龄大于50岁女性的2倍
s58 Sentence Low-income whites were more likely to have late-stage diagnosis than high-income whites 低收入的白人相对于高收入的白人,更容易罹患晚期乳腺癌
s59 Sentence Sample size: 19,711 study (100% screened after entry CBE) and 19,694 control 样本量:试验组有19,711例受试者(在入组CBE检查后,受试者100%完成了后续筛查),对照组有19,694例受试者
s60 Sentence Recommendations for subsequent mammograms vary, but evidence for various strategies is scant 进行乳腺X线摄影随访的建议尚未统一,且不同随访策略的证据尚属不足
s61 Sentence Other trials have been audited to varying degrees, usually with less rigor 其他试验的审核程度则各有不同,常常会较为宽松
s62 Sentence Based on solid evidence, screening mammography may lead to the following benefit: 确凿的研究证据证明,进行乳腺癌筛查可能存在以下获益:
s63 Sentence Accuracy in the community setting might be lower than in the RCT 社区诊所CBE的准确性可能不如RCT研究
s64 Sentence Analysis: Evaluation, with 1-year delay in the posttrial MMG in control group 分析方法:评估分析法,而对照组在试验结束后进行MMG的时间晚了1年
s65 Sentence (Refer to the PDQ summary on Breast Cancer Treatment for more information.) (更多信息参见乳腺癌的治疗 相关PDQ总结)
s66 Sentence One should remember that the intervention consisted of both MMG and CBE 此外,读者应该谨记本试验的干预措施包括了MMG和CBE
s67 Sentence Two international trials of CBE are under way in India and Egypt 此外,印度及埃及仍有两项有关CBE的国际间临床试验正在进行之中
s68 Sentence (refer to the Special Populations section of this summary for more information) (更多信息参见本份总结的特殊人群部分)
s69 Sentence Cause of death assessment blinded for women with a breast cancer diagnosis 乳腺癌患者不知道死亡原因的分析情况
s70 Sentence Sample size: 25,214 study (100% screened after entry CBE) and 25,216 control 样本量:试验组有25,214例受试者(在入组CBE检查后,受试者100%完成了后续筛查),对照组有25,216例受试者
s71 Sentence All of the studies accounted for stage, nodal status, and tumor size 所有研究均考虑了肿瘤的分期、淋巴结情况及肿瘤大小
s72 Sentence Treatment consists of surgery, radiation, and systemic adjuvant hormone therapy or chemotherapy 男性乳腺癌的治疗方法包括手术、放疗及系统性的辅助性激素治疗或化疗
s73 Sentence The examination is performed by compressing the breast firmly between two plates 该检查主要通过在两块平板间压紧乳腺组织,进行成像
s74 Sentence Radiation exposure is 4 to 24 mSv per standard two-view screening examination 标准的两个体位筛查技术单次放射剂量为4-24mSv
s75 Sentence Validation by analysis of age in both groups shows no significant difference 在两组间针对年龄进行的分析并未显示显著差异
s76 Sentence Based on solid evidence, screening mammography may lead to the following harms: 确凿的证据显示,使用乳腺X线摄影筛查可能会导致下列危害:
s77 Sentence Cancers diagnosed at entry in both study and control groups were included 两组中在入组前已被诊断为乳腺癌的受试者均被纳入试验范围
s78 Sentence Cluster randomization sometimes led to imbalances between the intervention and control groups 整群随机分组的一个弊端是可能会引起试验组与对照组之间的不平衡
s79 Sentence Statistical Modeling of Breast Cancer Incidence and Mortality in the United States 美国乳腺癌的发病率和死亡率的统计建模
s80 Sentence Therefore, even with a specificity of 90%, most abnormal mammograms are false-positives 因此,虽然乳腺钼靶检查的特异性高达90%,大多数异常的X-线结果都是假阳性事件
s81 Sentence Intervention: Initial two-view MMG, then single-view MMG every 18 months × 4 试验组:第一次为双视图MMG,随后每隔18个月进行一次单视图MMG,共4次
s82 Sentence The testing is often accomplished over many months, which may cause anxiety 这些检查往往耗费数月时间,同时会引起焦虑
s83 Sentence Latency is at least 8 years, and the increased risk is lifelong 潜伏期至少8年,而且辐射导致患癌风险增加为终生效应
s84 Sentence The HR for survival of the symptomatic women was 0.79 (95% CI, 0.63–0.99) 症状检出乳腺癌患者的生存风险比为0.79(95%CI,0.63-0.99)
s85 Sentence Both views should include breast tissue from the nipple to the pectoral muscle 每一个体位都需要包含从乳头到胸肌的全部乳腺组织
s86 Sentence Compliance: Nonattenders to first screening (35% of the screened population) were not reinvited 依从性:未参与第一次筛查的受试者(占筛查总人群的35%)将不会再被录入试验
s87 Sentence Cause of death attribution: Determined by a team of local physicians (see Ostergotland) 死亡原因分析:由一组当地的临床医师判定(见上述东约特兰试验)
s88 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.83 (0.66–1.04) 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):0.83(0.66-1.04)
s89 Sentence The Hispanic women had higher body mass index, higher parity, and earlier pregnancies 结果显示,西班牙裔女性往往体重指数更高,产次更多,且妊娠时间更早
s90 Sentence Contrast-enhancing foci are seen frequently in healthy breasts, so false-positive results are common 增强检查经常在正常乳腺中检出强化病灶,因此磁共振检查的假阳性事件亦很常见
s91 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 1.02 (0.78–1.33) 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):1.02(0.78-1.33)
s92 Sentence Thus, the detection and treatment of nonpalpable DCIS often represents overdiagnosis and overtreatment 因此,检出并治疗触诊阴性的DCIS病灶常常意味着过度诊断和过度治疗
s93 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.80 (0.53–1.22) 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):0.80(0.53-1.22)
s94 Sentence Of these 12, there will probably be only one or two lives extended 这12例乳腺癌患者中,可能只有1-2例寿命能延长
s95 Sentence Cause of death attribution: 76% autopsy rate in early report, lower rate later 死亡原因分析:较早期研究中尸检率为76%,这一比例在其后的研究中有所下降
s96 Sentence Several models estimate an individual woman's risk based on these and other factors 基于上述及其他危险因素,已有多个模型可用于估算女性乳腺癌的个体化患病风险
s97 Sentence Initially 100%, decreased to 85.4% by screen five in the CBE only group 在单独CBE筛查组,试验初期100%的受试者完成了筛查,第五次筛查时该比例降至85.4%
s98 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.84 (0.63–1.12) 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):0.84(0.63-1.12)
s99 Sentence The remaining 21 to 34 abnormal screens will be true-positives, indicating breast cancer 其余21到34例异常病例为真阳性,即有乳腺癌
s100 Sentence First, Leningrad investigators cluster-randomized more than 100,000 women to BSE training or control 第一项研究是列宁格勒研究,共100,000例女性入组,并使用群体随机分组法将其分为BSE训练组及对照组
s101 Sentence It does not provide formal guidelines or recommendations for making health care decisions 本总结不提供正式指南,亦不提供医疗决策建议
s102 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.68 (0.52–0.89) 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):0.68(0.52-0.89)
s103 Sentence Black women older than 65 years are less likely to undergo mammogram screening 年龄大于65岁的黑人女性更少进行乳腺钼靶筛查
s104 Sentence Breast cancer risk is affected by many factors besides participation in screening activities ​除筛查手段干预外,乳腺癌的发生风险还取决于多种因素
s105 Sentence The major predictors of radiation risk are young age at exposure and dose 射线暴露危害的重要预测因素为射线剂量,以及接受射线暴露时年龄偏小
s106 Sentence Generally, CAD systems increase sensitivity and decrease specificity and increase detection of DCIS CAD系统通常会增加摄片的敏感性、降低特异性,并提高导管内原位癌的检出率
s107 Sentence Mammography Facility Surveys, Mammography Equipment Evaluations, and Medical Physicist Qualification Requirement under MQSA 基于MQSA的乳腺X线摄影机构调查、乳腺X-线成设备评估和医师资格要求
s108 Sentence Expert-reviewed information summary about tests used to detect or screen for breast cancer 关于乳腺癌检测或筛查的专家审核信息
s109 Sentence Inclusion of these data in the Swedish meta-analysis resolves many of these questions 而瑞典荟萃分析在对这些数据进行解析时解决了大部分问题
s110 Sentence Some cancers, particularly those associated with BRCA 1/2 mutations, masquerade as benign tumors 而另外一些肿瘤,特别是伴有BRCA1/2突变的肿瘤,常常会表现为良性肿瘤特征
s111 Sentence Nine women developed invasive breast cancer and four women died of the disease 结果显示,其中9名女性发展为浸润性乳腺癌,而4名女性死于这一疾病
s112 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.81 (0.62–1.07) 乳腺癌相关死亡的相对危险度,筛查组对比对照组(95%CI):0.81 (0.62-1.07)
s113 Sentence (Refer to the Randomized controlled trials section of this summary for more information.) (更多信息参见本总结的随机对照临床试验章节)
s114 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.97 (0.74–1.27) 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):0.97(0.74-1.27)
s115 Sentence Study Design : Descriptive population-based comparisons, autopsy series, and series of mammary reduction specimens ​研究设计: 基于人群的对比性描述性研究、尸检病例研究、乳腺切除标本的系列研究
s116 Sentence If specificity is low, many false-positive examinations result in unnecessary follow-up examinations and procedures 如果特异性较低,就意味着假阳性事件增多,这会导致不必要的进一步随访检查和干预
s117 Sentence Baseline breast cancer incidence and mortality were comparable between the randomly assigned geographic clusters 对随机分组的地理集群,研究者比较了基础乳腺癌的发病率和死亡率
s118 Sentence Length bias: Mammography detects a cancer while it is preclinical, and preclinical durations vary 病程偏倚:乳腺X线摄影可以在出现症状前检测出肿瘤,而不同患者的潜伏期长短不一
s119 Sentence A study of California Medicare beneficiaries aged 65 to 79 years demonstrated this clearly 一项对加利福尼亚65-79岁之间的医疗保险获益者的研究,清楚地说明了这一点
s120 Sentence The number of extended lives attributable to mammographic detection is between two and six 由乳腺X线检出肿瘤而延长寿命的人数约为2-6
s121 Sentence Twenty women developed breast neoplasms (13 invasive and 7 ductal carcinoma in situ [DCIS]) 其中,20名女性被诊断为乳腺肿瘤(13例浸润性乳腺癌和7例导管内原位癌[DCIS])
s122 Sentence Relative risk of breast cancer death, screening versus control (95% CI): 0.82 (0.64–1.05) Ostergotland 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):东约特兰试验为0.82(0.64-1.05)
s123 Sentence Performance of both technologies has been compared directly in several trials yielding similar results 不少临床试验比较了两种技术的筛查效果,得出的结论类似
s124 Sentence No corresponding decline in incidence in women older than 69 years was ever seen 而对于年龄大于69岁的女性,发病率并未出现相应的下降
s125 Sentence Several observational population-based comparisons consider breast cancer incidence before and after adoption of screening 部分基于人群的观察性研究对比了应用筛查手段前后乳腺癌发病率的差异
s126 Sentence In 5 years, 311,082 screening examinations were done by SFM and 56,518 by FFDM 5年内,共进行过311,082例SFM筛查和56,518例FFDM筛查
s127 Sentence Randomization: Geographic cluster, with stratification for residence (urban or rural), socioeconomic factors and size 随机分组:地理集群分组,并根据居住地(城镇或乡村)、社会经济因素和体型进行分层
s128 Sentence Randomization: Cluster by physician practices, though many randomization assignments were changed after study start 随机分组:根据临床医师诊所进行集群分组,然而试验开始后许多随机分组安排均已改变
s129 Sentence The prevalence of cancer in women who died of noncancer causes is surprisingly high 事实上,在死于非肿瘤原因的女性中,癌的患病率出乎意料地高
s130 Sentence Compliance: Initially 100%, decreased to 86.7% by screen five in the MMG and CBE group 依从性:在MMG联合CBE组,试验初始100%的受试者完成了筛查,第五次筛查时该比例降至86.7%
s131 Sentence Contamination: 25% of women entering the study had MMG in the 3 years before entry 干扰:25%的受试者在入组前3年内曾进行过MMG
s132 Sentence Women with breast symptoms are not candidates for screening because they require a diagnostic evaluation 存在乳房症状的女性往往需要进行诊断性评估,故此类女性并非乳腺癌筛查目标
s133 Sentence The natural history of DCIS is poorly understood because nearly all DCIS cases are treated 由于几乎所有的DCIS病例均被治愈,因此人们对DCIS的自然病史了解甚少
s134 Sentence Thus, fewer than 1 of 6 women diagnosed with breast cancer die of the disease 在罹患乳腺癌女性中,只有不到六分之一的女性会死于这一疾病
s135 Sentence The two Malmo trials MMST I and MMST II have been combined for most analyses 在多数分析中都将马尔默的两项研究,即MMST I和MMST II结合起来
s136 Sentence Sample size: 30,000 to 31,092 in study group and 30,565 to 30,765 in control group 样本量:实验组为30,000到31,092例受试者;对照组为30,365到30,765例受试者
s137 Sentence By comparison, about 72,330 American women are estimated to die of lung cancer in 2014 而仅在2014年,就有约72,330名美国女性死于肺癌
s138 Sentence If this was prior to the study period then she was excluded from the analysis 若疾病诊断发生于入组之前,则分析中排除该受试者
s139 Sentence Large differences in socioeconomic status between practices were not recognized until after the study end 直至试验结束后,不同诊所之间社会经济状态间的巨大差异才受到关注
s140 Sentence The moderate- and high-risk groups had higher recurrence rates, and they benefited from postlumpectomy radiation 相反,中危组及高危组的复发率均较高,且应用术后放疗有所收益
s141 Sentence Nipple aspirate fluid was obtained from 417 women, but only 111 (27%) were adequate samples 其中417例女性采集到乳头抽吸液,但只有111例(27%)的样本量是充足的
s142 Sentence There were also differences in the methodology used to analyze the results of these trials 此外,不同临床试验用于分析结果的方法亦有所不同
s143 Sentence The single RCT comparing high-quality CBE to screening mammography showed equivalent benefit for both modalities 一项对比高质量CBE和筛查性乳腺X线摄影的独立RCT研究发现,二者有效性基本一致
s144 Sentence Additional testing was performed in 66% of these women, including invasive procedures performed in 27% 在这些寻求医疗干预的女性中,66%会接受过度检查,而27%甚至会采取有创操作
s145 Sentence There is no evidence for performing screening mammography in average-risk women younger than 40 years 尚无证据支持在年龄小于40岁的中危女性中推广乳腺X线摄影筛查
s146 Sentence The likelihood decreases for follow-up examinations, ranging from 1 to 3 cancers per 1,000 screens 而随访筛查检出乳腺癌的可能性则有所下降,每1000例筛查女性中可检出1-3例乳腺癌
s147 Sentence Attempts to define low-risk DCIS cases that can be managed with less therapies are important 低危DCIS病例可通过更少的治疗控制,因此明确诊断此类DCIS显得十分重要
s148 Sentence Discomfort with the ductal lavage procedure was judged by participants to be comparable to mammography 此外,受试者认为乳管灌洗操作所带来的不适感,与乳腺X线摄影的不适感相似
s149 Sentence Breast MRI is more sensitive but less specific than screening mammography and is more expensive 相比于筛查性乳腺X线摄影,乳腺MRI更为敏感,但更不特异,价格更高
s150 Sentence Clinical breast examination and breast self-exam have also been evaluated but are of uncertain benefit 临床乳腺检查及乳腺自我检查亦经研究评估,但是否有效尚未可知
s151 Sentence For women of all ages, high breast density is associated with 10% to 29% lower sensitivity 对于任何年龄的女性而言,腺体密度较高均与敏感性下降有关,约下降10%到29%不等
s152 Sentence Most cases are diagnosed during the evaluation of palpable lesions, which are generally easy to detect 其中,大部分病例是在出现可触及的病灶后做出诊断,而可触及的病灶往往比较容易被发现
s153 Sentence Individuals at Increased Risk of Breast Cancer and Thus Possibly With More to Gain From Screening 乳腺癌风险增高因而可能从筛查中获益更多的个体
s154 Sentence However, this study largely agrees with some similar analyses from other countries (see studies discussed above) 不过,上述研究的结果与其他城市的类似研究结果(见前文所述研究)大致符合
s155 Sentence Comments: This is the only trial specifically designed to study women aged 40 to 49 years 评论:本项试验是唯一一项专门针对年龄在40到49岁间的女性设计的试验
s156 Sentence Predictors of more advanced stage at diagnosis included Hispanic race (odds ratio, 2.12) and younger age 初诊诊断为晚期肿瘤的预测因素包括西班牙裔(比值比为2.12)和年龄较小
s157 Sentence These differences are associated with socioeconomic status and may reflect lack of participation in screening activities 这些差别与社会经济状态不同有关,并且可能反映出其缺乏筛查
s158 Sentence Randomization: Individual, within each birth year cohort for the first phase, MMG screening trial (MMST I) 随机分组:个体随机分组,MMG筛查试验一期临床试验(MMST I)将受试者根据出生年份分为不同的队列
s159 Sentence There are also many other places to get materials and information about cancer treatment and services 您也有很多其他途径可得到关于癌症治疗与服务的材料和信息
s160 Sentence Cause of death attribution: From the National Health Service (NHS) central register, death certificate code accepted 死亡原因分析:数据来源于英国国民医疗保健系统中心登记处,包括死亡证明代码等
s161 Sentence Similar findings suggestive of overdiagnosis have been reported from the United Kingdom and the United States 英国及美国有关过度诊断的研究亦得到类似的结果
s162 Sentence Unfortunately, the populations may differ in time, geography, culture, and the use of postmenopausal hormone therapy 但遗憾的是,人群在多个方面存在不一致性,包括时间、地理、文化、是否应用绝经后激素替代治疗等
s163 Sentence Analysis: Follow-up method intention-to-treat (though all women aged 50 years would be offered screening by NHS) 分析方法:对意向治疗集进行随访分析(尽管NHS向所有50岁女性提供筛查)
s164 Sentence Breast cancer is most often diagnosed by pathologic review of a fixed specimen of breast tissue 乳腺癌的诊断最常通过对乳腺组织固定标本进行病理学分析得到
s165 Sentence Cause of death attribution: Death certificates, with review of questionable cases by a blinded review panel 死亡原因分析:根据死亡证明确定,部分可疑病例交由不了解实验详情的审核小组核定
s166 Sentence (Refer to the PDQ summaries on Cancer Prevention Overview and Breast Cancer Prevention for more information.) (更多信息参见 肿瘤预防总论 和 乳腺癌的预防 等PDQ总结)
s167 Sentence For all these potential harms of screening mammography, internal validity, consistency and external validity are good 对于上述所有乳腺X线摄影筛查导致的潜在危害,其内部效度、一致性及外部效度均较佳
s168 Sentence Because this population is small, there are no studies to confirm the benefit of this recommendation 因这一群体人数较少,目前尚无研究证实该提议的获益
s169 Sentence The Swedish meta-analysis excluded all women with a prior breast cancer diagnosis, regardless of group assignment 瑞典荟萃分析则不考虑分组,将所有既往诊断为乳腺癌的女性予以排除
s170 Sentence Computed radiography (CR) utilizes a cassette-based removable detector and external reading device to generate a digital image 计算机X-线成像技术(CR)使用可移动暗箱式检测仪和外源性阅片设备以获取数字化影像
s171 Sentence Overall however, there were 86 more women excluded from the intervention group than from the control group 但总体上,干预组剔除的病例数比对照组多出了86例
s172 Sentence Although a correction factor was used in the final analysis, this may not adjust the analysis sufficiently 尽管最终分析采用了校正因子,但可能尚不足于校正分析结果
s173 Sentence Updated statistics with estimated new cases and deaths for 2014 (cited American Cancer Society as reference 1) 更新2014年新发病例与死亡病例的统计学数据(引用美国癌症研究所数据作为参考1)
s174 Sentence The participation rate of study women was 74% for the first round and 70% for subsequent rounds 第一次筛查时试验组女性受试者的参与度为74%;后续筛查时参与度均为70%
s175 Sentence Radiologist performance is critical to assessing mammographic interpretive performance, yet there is substantial, well-documented variability among radiologists 影像科医师的专业技能对于评价乳腺X线摄影的分析效能至关重要;而这种技能在不同的影像科医师间存在巨大而显著的差别
s176 Sentence The corresponding numbers and percentages for nipple aspiration fluid were 16 (6%), 8 (3%), and 1 (<1%) 这三种诊断在乳头抽吸液检查的比例分别为16例(6%)、8例(3%)和1例(<1%)
s177 Sentence No randomized trials of clinical breast examination (CBE) as a sole screening modality have yet been reported 尚未有将临床乳腺检查(CBE)作为独立的筛查手段的随机试验被报道
s178 Sentence Among regular users of mammography, however, cancer was diagnosed in black and white women at similar stages 然而事实上,在常规应用乳腺钼靶筛查的患者中,黑人女性及白人女性所检出的肿瘤期别类似
s179 Sentence Overdiagnosed disease is a neoplasm that would never become clinically apparent without screening before a patient’s death 过度诊断指如果没有筛查,该肿瘤在患者死亡之前都不会引起任何临床表现
s180 Sentence For routine screening in the United States, examinations are taken in both mediolateral oblique and craniocaudal projections 在美国,乳腺常规筛查通常需用到两个体位摄片:内外斜位和头尾位
s181 Sentence The group that received BSE training had more breast biopsies but no improvements in breast cancer mortality 接受BSE训练的试验组进行乳腺活检的病例更多,但在乳腺癌相关死亡率方面并无提高
s182 Sentence Various methods to analyze breast tissue for malignancy have been proposed as screening methods for breast cancer 多种分析乳腺组织是否恶性的方法被提议用作乳腺癌的筛查手段
s183 Sentence The trials are described in detail in the Appendix of Randomized Controlled Trials section of this summary 更多临床试验的细节详见本总结的附录:随机对照临床试验一节
s184 Sentence Such compression spreads out overlapping tissues and reduces the amount of radiation needed to image the breast 这样的挤压可以展开重叠组织,并降低成像所需的放射剂量
s185 Sentence A total of 383 ductal lavage samples were evaluated, 299 (78%) of which were adequate for diagnosis 此外,共有383例女性采集到乳管灌洗液,而只有299例(78%)的样本量足够做出诊断
s186 Sentence Cause of death attribution: Linked to Swedish Cause of Death Registry; also used an independent endpoint committee 死亡原因分析:连接瑞典死亡原因登记处;也由独立的终点委员进行分析
s187 Sentence Investigators also differ in their calculation of overdiagnosis as they adjust for characteristics such as lead-time bias 此外,由于存在如领先时间偏倚等混杂因素,不同研究者在校准这些因素的同时对过度诊断的计算也会产生差异
s188 Sentence A large concurrent cohort study compared 254,758 FFDM screens with 487,334 SFM screens and 74,190 CR screens 一项同期大型多队列研究共纳入254,758例FFDM筛查,487,334例SFM筛查,74,190例CR筛查结
s189 Sentence However, breast cancer cases and deaths were adjudicated by a Swedish panel that included the trial's investigators 但是乳腺癌发生病例及死亡数经由瑞典专家组最终裁定,该专家组中包括研究者
s190 Sentence Breast cancer incidence rates increase at the initiation of screening without a compensatory drop in later years 事实上,随着筛查的广泛应用,乳腺癌发病率在筛查之初出现上升,但后来并未出现代偿性下降
s191 Sentence In a separate study, adjuvant tamoxifen therapy was shown to reduce the incidence of invasive breast cancer 另一项不同的研究提示,他莫昔芬辅助治疗可以降低浸润性乳腺癌的发生率
s192 Sentence Factors that influence radiologists’ performance include their level of experience and the volume of mammograms they interpret 可能会影响放射科医师表现的因素包括:经验水平以及他们曾经阅读过的乳腺X线摄影片的数量
s193 Sentence Importantly, cancer detection was lower for CR at 3.4 per 1,000, adjusted OR 0.79 (95% CI, 0.68–0.93) 更为重要的时,CR组的肿瘤检出率为每1,000例中检出3.4例,低于前两组;其调整后的OR值为0.79(95%CI,0.68-0.93)
s194 Sentence Compression of the breast is important during a mammogram to reduce motion artifact and improve image quality 在乳腺X线摄影的实施过程中,为了减少身体活动引起的伪影并提高影像质量,挤压乳腺是一项重要的操作
s195 Sentence Breast cancer incidence and mortality risk also vary according to geography, culture, race, ethnicity, and socioeconomic status ​乳腺癌发病率和死亡风险随着地理分布、文化、种族、民族及社会经济状态的不同而不同
s196 Sentence Magnitude of Effect : The current evidence is insufficient to assess the additional benefits and harms of CBE 效应强度: 现有证据尚不充足,无法评价CBE的益处及危害
s197 Sentence The cumulative biopsy rate (the rate of true-positives) due to mammographic findings was approximately 1 in 4 (23.6%) 根据乳腺钼靶检查的结果,累积活检率(真阳性率)约为1/4(23.6%)
s198 Sentence Sample size: Variably reported, ranging from 38,405 to 39,034 in study and from 37,145 to 37,936 in control 样本量:报道各有不同,试验组和对照组的受试者数量分别为38,405-39,034例和37,145-37,936例
s199 Sentence Intervention: Initially, two-view MMG and CBE; then annual CBE, with single-view MMG in years 3, 5, and 7 试验组:第一次筛查为双视图MMG联合CBE;此后每年进行一次CBE,并分别在第3、5和7年,进行一次单视图MMG
s200 Sentence The second study considered an 11-year period comparing seven counties with screening programs to five counties without them 第二项研究历时11年,将7个开展筛查项目的城市与5个未开展筛查项目的城市进行对比
s201 Sentence Of all breast cancers detected by screening mammograms, up to 54% are estimated to be results of overdiagnosis 经评估,在通过乳腺X线摄影筛查发现的所有乳腺肿瘤中,多达54%的病例为过度诊断
s202 Sentence Exclusions: A similar proportion of women were excluded from both groups for prior breast cancer diagnosis (1.2% each) 排除:两组均排除了既往有乳腺癌诊断的女性,且排除比例类似(每组均为1.2%)
s203 Sentence Digital mammography is more expensive than screen-film mammography (SFM) but is more amenable to data storage and sharing 数字乳腺X线摄影的检查价格高于乳腺屏-片检查(SFM),但在数据储存及分享方面更为先进
s204 Sentence Because of the rarity of the disease, it is extremely unlikely that any screening modality would be useful 由于疾病十分少见,各种筛查性手段基本无效
s205 Sentence Understanding and quantifying these risks is important to a woman, to her physicians, and to public policy makers 理解并量化这些风险对于女性患者、临床医师、及公共政策制定者而言都是非常重要的
s206 Sentence Sample size: Variably reported, ranging from 38,562 to 39,051 in intervention and from 18,478 to 18,846 in control 样本量:报道各有不同,试验组和对照组的受试者数量分别为38,562-39,051例和18,478-18,846例
s207 Sentence Comments: No reduction for women aged 50 to 54 years, but similar reductions for other 5-year age groups 评论:对年龄在50到54岁间的女性,并未发现筛查组结局事件减少;而其他5年差年龄组均发现类似的下降
s208 Sentence Unfortunately, these attempts could not ensure a lack of knowledge of women’s assignments to screening or control arms 但上述手段不能保证对受试者分组情况的保密
s209 Sentence A meta-analysis comparing digital mammography with film mammography included 10 studies and involved 82,573 women who underwent both types 一项结合10项研究的荟萃分析,共纳入82,573例使用乳腺数字和屏-片X线检查进行筛查的女性,并对两种筛查结果进行对比
s210 Sentence The meta-analysis (follow-up methods) of the four Swedish trials also showed a small but significant improvement of all-cause mortality 而针对四项瑞典临床试验进行的荟萃分析(随访分析法)同样显示实验组全因死亡率的轻度下降,且这种改变具有统计学意义
s211 Sentence A major limitation of this and other ecologic studies is the failure to account for actual exposure to screening 此外,上述及其他生态学研究的最主要限制在于,无法显示筛查的真实覆盖范围
s212 Sentence There is often a trade-off between sensitivity and specificity, such that higher sensitivity may be associated with lower specificity 敏感性和特异性之间往往存在一种折衷,比如较高的敏感性常常伴随较低的特异性
s213 Sentence CAD systems are designed to help radiologists read mammograms by highlighting suspicious regions such as clustered microcalcifications and masses CAD系统通过放大可疑区域,如簇状微钙化和肿块,以辅助影像科医师阅读乳腺X线摄影的结果
s214 Sentence Fellowship training in breast imaging may lead to improved cancer detection, but it is associated with higher false-positive rates 乳腺影像方面的专科训练也可能会增加肿瘤的检出率,但是它同时也与较高的假阳性率有关
s215 Sentence Despite these considerations, many women with poor life expectancy due to age or health status often undergo screening mammography 尽管有上述疑虑,很多因为年龄或健康状态而预期寿命有限的女性仍然常常会进行乳腺钼靶筛查
s216 Sentence Three population-based, observational studies from Sweden compared breast cancer mortality in the presence and absence of screening mammography programs 瑞典的3项基于人群的观察性研究对比了在有无乳腺X线摄影筛查的情况下,乳腺癌相关死亡率的差别
s217 Sentence The study design and conduct make these results difficult to assess or combine with the results of other trials 本项研究的研究设计和实施过程,使得该研究结果难以进行评估或与其他试验结果进行联合分析
s218 Sentence The breast dose associated with a typical two-view mammogram is approximately 4 mSv and extremely unlikely to cause cancer 经典双视图乳腺X线摄影的辐射剂量约为4 mSv,几乎不可能导致肿瘤产生
s219 Sentence Contamination: Screening MMG was not available outside the trial, but frequency of CBE performance among control women is unknown 干扰:在本试验外无法进行筛查性MMG检查,但对照组女性CBE检查频率未知
s220 Sentence The breast tissue can be obtained from a symptomatic area or from an area identified by an imaging test 乳腺组织一般取材自有症状部位或影像学检查发现异常的部位
s221 Sentence Individual for the entire birth cohort 1933 to 1945 for MMST II, but with variations imposed by limited resources 而MMST II期试验收录了出生年份为1933年到1945年的女性组成完整队列,但是存在由于资源有限导致的差异
s222 Sentence Control: Control group received one screening exam approximately 3 to 8 months after the final screen in study group 对照组:试验组最后一次筛查后3到8个月,对照组接受一次筛查检查
s223 Sentence Randomization: Individuals from lists of general practitioners in geographically defined areas of England, Wales, and Scotland; allocation was concealed 随机分组:根据英格兰、威尔士和苏格兰的地理分区对诊所就诊的女性进行分组;分组名单保密
s224 Sentence Comments: Evaluation analysis required a correction factor for the delay in the performance of MMG in the control group 评论:对照组的MMG筛查时间晚于试验组,因此评估分析需对此给出校正因子
s225 Sentence Screening for breast cancer does not affect overall mortality, and the absolute benefit for breast cancer mortality is small 乳腺癌筛查并不影响总体死亡率,且其对乳腺癌死亡率的绝对获益很小
s226 Sentence Comments: The MMGs were of poor quality compared with those of later trials, because of outdated equipment and techniques 评论:本试验所应用的MMG检查由于采用了过时的技术和设备,其检查质量相比于之后的临床试验来说更差
s227 Sentence Healthy volunteer bias: The screened population may be the healthiest and/or the most health-conscious women in the general population 健康志愿者偏倚:选择进行筛查的人群通常是总体人群中最为健康,或者说最关注自身健康状态的女性
s228 Sentence In particular, the breast cancer mortality-focused, randomized, controlled trials used single screening intervals with little variability across the trials 一般来说,用于研究乳腺癌相关死亡率的随机对照研究多采用固定的筛查间隔,且在不同临床试验间变异不大
s229 Sentence Control: Those who were not invited received usual medical care, unaware of their participation, and few screened prior to randomization 对照组:未被邀请进入试验组的受试者接受常规医疗护理,且并不知晓已参与试验,其中只有极少受试者在随机分组前接受过筛查
s230 Sentence Overall, the biggest risk factor for having a false-positive mammogram was the individual radiologist’s tendency to read mammograms as abnormal 总体上,导致乳腺钼靶检查结果出现假阳性的危险因素中,最有力的一项是该患者的放射科医师倾向于做出异常诊断
s231 Sentence False-positive rates vary significantly between facilities performing diagnostic mammography and are higher at facilities where concern about malpractice is high 不同机构在进行诊断性乳腺X线摄影时,其假阳性率相差巨大;对医疗事故顾虑较高的机构假阳性率通常会较高
s232 Sentence By design, controls did not have regular clinic visits, so the prestudy cancer status of control patients was not determined 根据试验设计,对照组不会进行规律的临床随访,因此对照组受试者在入组前的肿瘤状态难以明确
s233 Sentence Menopausal hormone use, obesity, lack of physical activity, and alcohol intake are associated with an increased risk of breast cancer 绝经后激素替代治疗、肥胖、缺乏锻炼及饮酒等亦与乳腺癌发生风险增加有关
s234 Sentence Exclusions: Women with pre-existing breast cancer were excluded from both groups, but the numbers are reported differently in different publications 排除标准:干预组和对照组中均排除既往患有乳腺癌的女性,但不同报告中排除数量各有不同
s235 Sentence Two prior studies of noncontemporaneous cohorts showed no difference between CR and SFM or higher cancer detection rate from CR 此前两项非同期队列研究显示,CR组与SFM组的肿瘤检出率并无差异,且CR组的肿瘤检出率并无提高
s236 Sentence The recall rate was higher in the FFDM group, but there was no difference in detection of invasive breast cancer FFDM组的召回率高于SFM组,但两组的侵袭性乳腺癌检出率无差异
s237 Sentence One study reported results of nipple aspiration followed by ductal lavage in 507 women at high risk for breast cancer 另外一项研究对507例乳腺癌高危女性进行乳头抽吸液检查以及乳管灌洗液检查
s238 Sentence Performance benchmarks for screening mammography in the United States are described on the Breast Cancer Surveillance Consortium (BCSC) Web site 在美国,乳腺X线摄影筛查的性能评估基准详见乳腺癌监管联合会(BSCS)网站
s239 Sentence These findings are interesting but probably not relevant to women with screen-detected DCIS in an era of improved cancer care 这些发现尽管十分有趣,但在癌症治疗得到进步的当代,这些结果可能与筛查诊断DCIS的女性患者无关
s240 Sentence Exclusions: More women (338) with pre-existing breast cancer were excluded from the intervention group than from the control group (177) 排除标准:两组均将既往患有乳腺癌的女性排除,但试验组(338例)剔除的病例数多于对照组(177例)
s241 Sentence Other trials used a "follow-up" analysis, which counts all deaths attributed to breast cancer, regardless of the time of diagnosis 另一些临床试验则采取“随访”分析法,即不考虑乳腺癌的诊断时间,记录下所有乳腺癌致死的病例数
s242 Sentence Population-based studies could demonstrate the extent of overdiagnosis if the screened and nonscreened populations were the same except for screening ​假设进行筛查和未进行筛查的人群除了是否进行筛查外,其他指标都保持一致,因此就可以通过基于人群的研究来描述过度诊断的程度
s243 Sentence One study in 11 rural Swedish counties showed a persistent increase in breast cancer incidence following the advent of screening 一项在瑞典11个乡镇中开展的研究显示,在乳腺癌筛查出现后,乳腺癌发病率呈现持续性上升
s244 Sentence Thermographic devices have been approved by the FDA under the 510(k) process, which does not require evidence of clinical effectiveness 热像图仪器已经过FDA 510(K)系统批准,不需要临床证据支持其疗效
s245 Sentence Both breast cancer incidence and mortality are lower among Hispanic and Asian/Pacific Islander women than among white and black women 西班牙裔和亚裔/太平洋岛居民相比于白人或黑人女性,乳腺癌发病率和相关死亡率都较低
s246 Sentence Thus, method of cancer detection is a powerful predictor of patient outcome, which is useful for prognostication and treatment decisions 因此,肿瘤检出的方式的确是患者结局的有力预测因素,对判断患者预后并决定治疗方式十分有用
s247 Sentence As a consequence, the magnitude of overdiagnosis due to mammographic screening is controversial, with estimates ranging from 0% to 54% 因此,就乳腺钼靶筛查而言,过度诊断的程度大致波动于0%到54%之间,尚有很大争议
s248 Sentence While screening mammography may yield cancer diagnoses in approximately 1% of elderly women, many of these cancers are low risk 尽管在老年女性中进行乳腺钼靶筛查的肿瘤检出率约为1%;然而这些肿瘤中大部分都是低危肿瘤
s249 Sentence Mammography is the most widely used screening modality, with solid evidence of benefit for women aged 40 to 74 years 乳腺X线摄影是应用最为广泛的筛查手段,对于40-74岁之间的女性,有充分证据显示该筛查手段有益
s250 Sentence Contamination: 13% of women in the Two-County trial had MMG as part of routine care, mostly between 1983 and 1984 干扰:双城试验中13%的女性应用MMG作为常规筛查的一部分,其中大部分发生于1983和1984年
s251 Sentence Technologies such as ultrasound, magnetic resonance imaging, tomosynthesis, and molecular breast imaging are being evaluated, usually as adjuncts to mammography 其他处于研究评估的检测技术还包括:超声波、磁共振成像、断层融合技术及乳腺分子成像技术等,多用于乳腺X线摄影的辅助检查
s252 Sentence Most of the reduction in breast cancer mortality, the authors concluded, was probably because of improved treatment rather than screening 研究者因此猜测,导致乳腺癌相关死亡率下降最主要的原因可能是治疗手段的提高,而非筛查的应用
s253 Sentence In addition, a longer interval since the last mammogram increases sensitivity, recall rate, and cancer detection rate and decreases specificity 此外,距离最后一次乳腺筛查的时间间隔越长,再次行乳腺筛查检查的敏感性、召回率及肿瘤检出率均有所上升,同时特异性会下降
s254 Sentence Contamination: 13% of women in the Two-County trial had MMG as part of routine care, mostly in 1983 and 1984 干扰:双城试验中13%的女性应用MMG作为常规筛查的一部分,其中大部分发生于1983和1984年
s255 Sentence Screening biennially from age 50 to 69 years achieved a median 16.5% reduction in breast cancer deaths versus no screening 对于年龄在50-69岁间的女性,每2年筛查一次与不进行筛查相比,可以使得乳腺癌相关死亡病例数下降16.5%
s256 Sentence Women in the screening group were excluded based on determinations made during the study period at their initial screening visits 在筛查试验组,研究者会在试验过程中对患者进行初次筛查时做出判断
s257 Sentence Interval cancers are cancers that are diagnosed in the interval after a normal screening examination and before the subsequent screen 间期癌是指在一次筛查结果正常到下一次筛查之前的间期内所诊断的肿瘤
s258 Sentence CBE, lasting 5 to 10 minutes per breast, was conducted by trained health professionals, with periodic evaluations of performance quality CBE的检查应由训练有素的专业人士进行,每一侧乳腺检查应持续5到10分钟,且该专业人士应接受定期的质量评估
s259 Sentence The sensitivity of mammography is the percentage of breast cancers detected in a given population, when breast cancer is present 乳腺X线摄影的敏感性是指在已罹患乳腺癌的群体中检出肿瘤(阳性结果)的比例
s260 Sentence Sample size: Declined from 40,318 to 38,525 in intervention group and rose from 19,943 to 20,978 in control, between published reports 样本量:在已发表的不同报告中,试验组从40,318例降至38,525例受试者,而对照组从19,943例增至20,978例受试者
s261 Sentence Comments: There are concerns about randomization, especially in the second subtrial, about exclusions, and about the delay in control group MMG 评论:关于本试验的随机分组过程存在疑虑,尤其是第二个亚组试验。这些疑虑包括排除例数、对照组MMG时间延迟等
s262 Sentence Several studies, however, show that the anxiety following evaluation of a false-positive test leads to increased participation in future screening examinations 不过,亦有部分研究显示,假阳性事件所带来的焦虑感可能会导致受试者更积极地参与进一步筛查检查
s263 Sentence Another large study noted an increase in recall rate and increased DCIS detection but no improvement in invasive cancer detection rate 另一项类似的大型研究发现引入CAD系统后,召回率及DCIS检出率均有所上升,而浸润性乳腺癌的检出率并无改变
s264 Sentence Positive predictive value (PPV), which is the proportion of cancers detected per abnormal examination, was estimated to be 3% to 4% 此外,阳性预测值即乳腺筛查的异常结果中检出肿瘤的概率,约为3%到4%之间
s265 Sentence If a "normal" mammogram dissuades or postpones a woman or her doctor from evaluating breast symptoms, she may suffer adverse consequences 一份所谓“正常”的乳腺筛查结果会诱使受试者及其临床医师忽视评估乳腺症状,而该受试者可能会因而产生更为负面的后果
s266 Sentence When controlled for age, nodal status, and tumor size, screen-detected cancers had a lower risk of relapse and better overall survival 在控制了年龄、淋巴结情况、肿瘤大小等变量后,分析结果显示筛查检出的肿瘤复发风险更小,总体生存率更好
s267 Sentence There was higher detection of ductal carcinoma in situ (DCIS) in the FFDM group related to increased detection of clustered microcalcifications FFDM组导管内原位癌的检出率升高,与簇状微钙化检出率增高相关
s268 Sentence Development of breast cancer after treatment of DCIS depends on the characteristics of the lesion but also on the delivered treatment DCIS治疗后是否发生乳腺癌取决于病变的类型,同时也与实施的治疗相关
s269 Sentence Socioeconomic differences between study and control groups probably account for the higher all-cause mortality in control women compared with screened women 对照组的全因死亡率高于筛查组女性,这一结果极可能与两组间社会经济状态的差异有关
s270 Sentence The findings of this study are also consistent with the evidence that some screen-detected cancers are low risk and represent overdiagnosis 该项研究的这一发现也支持了筛查检出的肿瘤多为低危肿瘤及过度诊断的结果这一结论
s271 Sentence Ductal carcinoma in situ (DCIS) is a noninvasive condition that can evolve to invasive cancer, with variable frequency and time course 导管内原位癌(DCIS)为非浸润性癌,但可发展为浸润性癌;其发生率及病程多样
s272 Sentence In 2009, CISNET modelers addressed several questions related to the harms and benefits of mammography, including comparing annual versus biennial screening 2009年,CISNET的建模者对与乳腺X线摄影利弊相关的一些问题进行了研究,包括比较每年1次与每年2次筛查方案的区别
s273 Sentence Comments: This trial is unique in that it compares one screening modality to another, and does not include an unscreened control 评论:本试验对比了两种不同的筛查方式,且不包括未筛查的对照组;这是本试验与众不同的设计
s274 Sentence In these studies, MRI specificities range from 37% to 97%, with threefold to fivefold higher recall rates and substantially lower PPVs 在这些研究中,MRI的特异性波动于37%到97%,召回率为乳腺X-线检查组的3到5倍之多,且总体PPV较低
s275 Sentence Within each practice, there was inconsistent recruitment of women, according to the physician’s judgment about each woman’s suitability for the trial 由于每个诊所的医师需要判断就诊女性是否符合试验入组标准,因此受试者的录入并非持续进行
s276 Sentence Radiologists in academic settings have a higher positive predictive value (PPV) of their recommendations to undergo biopsy than do community radiologists 相比于社区医院的影像科医师,大型医疗中心的影像科医师在建议患者行进一步的活检检查时,其阳性预测值(PPV)往往更高
s277 Sentence By comparison, a single chest computed tomography (CT) scan delivers 7 mSv and an abdominal CT scan delivers 12 to 20 mSv 对比可知,单次胸部计算机断层扫描(CT)的辐射剂量为7 mSv,而单次腹部CT的辐射剂量则是12-20 mSv
s278 Sentence Monthly breast self-examination (BSE) has been promoted, but there is no solid evidence that it is effective in reducing breast cancer mortality 虽然推荐每月进行一次乳腺自我检查,但尚无确凿证据显示上述检查有利于降低乳腺癌相关死亡率
s279 Sentence Evidence of possible misclassification of breast cancer deaths in the Two-County Trial with possible bias in favor of screening has been analyzed 一项双城临床试验中,分析证据显示,乳腺癌导致的死亡病例可能存在误判,从而使试验结果向筛查组偏倚
s280 Sentence One study of 576 women with interval cancers reported that interval cancers are more prevalent in women aged 40 to 49 years 一项收录了576例女性间期癌患者的研究结果显示,间期癌更多见于40到49岁之间的女性
s281 Sentence (Refer to the subsection on Harms in the Screening With Mammography section of the Overview section of this summary for more information.) (更多信息参见本总结概述部分中 筛查:乳腺X线摄影的危害章节)
s282 Sentence Small cohort studies do not suggest any additional benefit for the use of thermography as an adjunct modality for breast cancer screening 一些小规模队列研究结果显示,使用热像图辅助乳腺癌筛查并不增加获益
s283 Sentence Breast self-examination (BSE) has been compared to usual care (no screening activity) but has not been shown to reduce breast cancer mortality ​曾有研究对比乳腺自我检查(BSE)与常规护理(即不进行筛查检查),结果提示BSE不能降低乳腺癌的死亡率
s284 Sentence Among breast cancer cases diagnosed from 2001 to 2007, 61% of white women and only 51% of black women had localized disease 2001年到2007年间诊断的乳腺癌病例中,61%的白人女性和51%的黑人女性为局灶性肿瘤
s285 Sentence Although several trials also show better cancer-related survival in screened versus nonscreened women, a number of important biases may explain that finding: 尽管有些临床试验提示经过筛查的女性人群相比于未经筛查的女性人群,肿瘤相关生存指数更优;但下述几项重要偏倚或许能解释这一结果的出现:
s286 Sentence (Refer to the Ductal Carcinoma In Situ section in the Breast Cancer Diagnosis and Pathology section of this summary for more information.) (更多信息参见本份总结的乳腺癌的诊断和病理学部分的导管原位癌章节)
s287 Sentence Relative risk of breast cancer death, screening versus control (95% CI): Aged 39 to 59 years: 0.79 (0.58–1.08) [evaluation]; 0.77 (0.60–1.00) [follow-up] 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%CI):年龄在39到59岁之间的女性:0.79(0.58-1.08)[评估分析法];0.77(0.60-1.00)[随访分析法]
s288 Sentence Although no such incremental decrease in breast cancer mortality was observed after the introduction of screening, their assumption makes their conclusion weak 然而事实上在筛查项目被推广后,研究者并未观察到乳腺癌相关死亡率呈现增量递减的趋势,因此研究者的设想反而使结果难以立足
s289 Sentence Mammography screening may be effective in reducing breast cancer mortality in certain populations, but it can pose harm to women who participate 使用乳腺钼靶检查进行筛查可能在特定人群中有效降低乳腺癌相关死亡率,但它同样会使被筛查者暴露于多种危害之中
s290 Sentence Of the 500 abnormal screens, 466 to 479 will be false-positives, and 100 to 200 of these women will undergo invasive procedures 而在500例筛查结果为阳性的患者中,约有466-479例为假阳性,其中100-200例女性将接受有创检查
s291 Sentence Although age-adjusted breast cancer incidence rates are higher in white women than in black women, mortality rates are higher in black women 尽管年龄调整后的乳腺癌发病率在白人中高于黑人,但黑人女性的死亡率却较高
s292 Sentence International comparisons of screening mammography have found higher specificity in countries with more highly centralized screening systems and national quality assurance programs 对不同国家的乳腺X线摄影筛查进行对比研究显示,在筛查系统高度集中、存在国家质量保证项目的国家,筛查的特异性更高
s293 Sentence Because large numbers of women have false-positive tests, the issue of psychological distress—which may be provoked by the additional testing—has been studied 研究已经发现筛查可能会导致心理问题,这是因为大量女性的检查结果为假阳性,而这种困扰会随着进一步的检查而加重
s294 Sentence As a general rule, interval cancers have characteristics of rapid growth and are frequently of advanced stage at the time of discovery/diagnosis 因此普遍的规律显示,间期癌多具有快速生长的特性,且在被发现/诊断之时常常处于中晚期
s295 Sentence Ecologic studies are difficult to interpret because of this type of potential uncontrolled confounding, as well as these types of unfair comparisons 正是由于上述潜在不可控混杂因素,及可能存在不公平的比较,使得生态学研究的结果较难解析
s296 Sentence The study was small in terms of number of deaths, with low power to discriminate breast cancer mortality between the two groups 但由于死亡病例数较小,无法判断两组的乳腺癌相关死亡率的差别
s297 Sentence Based on solid evidence, formal instruction and encouragement to perform BSE leads to more breast biopsies and diagnosis of more benign breast lesions ​可靠证据显示,正式指导并鼓励进行BSE会导致更多的乳腺活检,以及诊断出更多的乳腺良性病灶
s298 Sentence Another expression of this analysis is that one life may be extended per 1,700 to 5,000 women screened and followed for 15 years 换个说法,每1,700-5,000例接受筛查的女性,在随访15年后,有1例女性寿命延长
s299 Sentence Such women might have end-stage renal disease, severe dementia, terminal cancer, or severe comorbid disease with functional dependencies in activities of daily living 这样的女性往往患有终末期肾病、严重痴呆、末期癌症或导致日常活动受限的严重并发症
s300 Sentence A palpable lesion can be biopsied with core needle biopsy or, less often, fine-needle aspiration biopsy or surgical excision; image guidance improves accuracy 对可触及性肿块进行活检最常用的方式是粗针穿刺活检,其他较为少用的方式分别是细针抽吸活检及手术切除。此外,影像学导引下穿刺往往能提高准确性
s301 Sentence Achieving balance between the benefits and harms of screening is especially important for women with a life expectancy of 5 years or less 对于预期寿命不足5年的女性而言,筛查手段的利弊平衡十分重要
s302 Sentence Intervention: Three single-view MMGs every 2 years for women younger than 50 years and every 33 months for women 50 years and older 试验组:年龄小于50岁的女性每2年进行一次单视图MMG;年龄大于50岁的女性每33个月进行一次单视图MMG,共3次
s303 Sentence Magnitude of Effect : Varies with patient age, tumor type, and grade, and is greater with the first screen than subsequent screening examinations 效应强度: 效应强度随患者年龄、预期寿命和肿瘤类型(导管内原位癌,伴或不伴浸润)的不同而各异
s304 Sentence There have been no randomized trials of thermography to evaluate the impact on breast cancer mortality or the ability to detect breast cancer 尚无热像图相关随机临床试验用于评估热像图检出乳腺癌的能力,以及对乳腺癌相关死亡率的影响
s305 Sentence Among community clinicians, screening CBE has higher specificity (97%–99%) and lower sensitivity (22%–36%) compared with examiners in clinical trials of breast cancer screening 社区临床医师相比于临床试验的检查者,应用CBE进行乳腺癌筛查时具有较高的特异性(97%-99%) 和较低的敏感性(22%-36%)
s306 Sentence Subsequent analyses found the size and stage of the cancers detected mammographically in this trial to be equivalent to those of other trials 此外,后续分析发现本试验中由乳腺X线摄影检出的肿瘤中,其大小及期别与其他试验的数据相符
s307 Sentence A prospective United Kingdom trial randomly assigned women aged 50 to 62 years to receive mammograms annually or at the standard 3-year interval 英国一项前瞻性临床试验随机纳入年龄分布于50到62岁间女性患者,分为两组,分别以一年和三年为间隔进行规律的乳腺X线摄影筛查
s308 Sentence The accessibility of the data for international audits and verification also varies, with formal audit having been undertaken only in the Canadian trials 对不同数据进行国际审核和验证的可及性各有不同,而只有加拿大的临床试验采取正式的审核流程
s309 Sentence The primary role of ultrasound is the diagnostic evaluation of palpable or mammographically identified masses, rather than serving as a primary screening modality 超声检查的主要作用是对触诊或乳腺X线摄影检出的包块进行诊断性评估,而不用做初始筛查的手段
s310 Sentence Screening mammography and magnetic resonance imaging can identify early-stage cancers in these women, but the benefits and risks have not been clearly defined 乳腺钼靶筛查和磁共振成像可以在这些女性中检出早期癌症,但相关益处及风险尚不明确
s311 Sentence Some of these cancers were present at the time of mammography (false-negatives), and others grew rapidly in the interval between mammography and detection 其中一些肿瘤可能在第一次乳腺X线摄影中即存在(假阴性事件);而另一些则是在乳腺X线摄影筛查之后,迅速生长直至被诊断出
s312 Sentence Contamination: 24% of all control women had at least one MMG, as did 35% of the control women aged 45 to 49 years 干扰:24%的对照组受试者曾经接受过至少一次MMG,而对于年龄在45到49岁间的对照组女性而言,该比例为35%
s313 Sentence Nonpalpable lesions can be sampled by core needle biopsy using stereotactic x-ray or ultrasound guidance or can be surgically excised after image-guided localization 对临床触诊阴性的病灶进行活检通常是在立体定向乳腺X线摄影或超声导引下进行粗针穿刺活检,或者是在影像学引导定位后进行手术切除
s314 Sentence Currently, cancers that will cause illness and/or death cannot be confidently distinguished from those that will remain occult, so all cancers are treated ​目前,由于无法准确区分肿瘤会保持隐性状态,还是会引起疾病或导致死亡,因此所有的肿瘤都需要进行治疗
s315 Sentence A 10-year follow-up study of 1,983 Finnish women with invasive breast cancer demonstrated that the method of cancer detection is an independent prognostic variable 一项随访10年的研究共纳入1,983例芬兰浸润性乳腺癌女性患者,结果显示肿瘤检出方式是患者预后的独立危险因素
s316 Sentence A third study compared the outcomes of 5,604 English women with screen-detected cancers to those with symptomatic breast cancers diagnosed between 1998 and 2003 另外一项试验纳入了1998年至2003年间5,604例因筛查检出乳腺癌的英国女性受试者,并将分析结果与因症状检出乳腺癌的患者进行对比
s317 Sentence Among Hispanic women, there was no difference according to income, but all the Hispanic groups were at or below the lowest white income level 在西班牙裔女性中,不同收入的人群间却没有上述差别;不过事实上,所有西班牙裔人群都在白人的最低收入水平甚至更低
s318 Sentence Analyses that do not adjust for important patient characteristics may falsely conclude that there is more facility variation in overall accuracy than actually exists 因此,如果一项研究没有对重要的患者特征进行调整,就有可能错误地高估准确性在机构间的差异
s319 Sentence Males account for 1% of breast cancer cases and breast cancer deaths (refer to the Special Populations section of this summary for more information) 在乳腺癌病例及死亡病例中,1%为男性(更多信息参见本份总结的特殊人群部分)
s320 Sentence Thus, for women aged 40 to 49 years, it is estimated that one or two lives may be extended per 5,000 to 10,000 mammograms 估算可得,对于年龄在40到49岁间的女性而言,每进行5,000到10,000次乳腺X线摄影,1-2例女性寿命延长
s321 Sentence No differences in breast cancer detection were observed (AUC 0.78 +/- 0.02 for digital and AUC 0.74 +/- 0.02 for film; P = .18) 结果提示两种成像技术在乳腺癌检出方面并无差别(数字成像术的AUC为0.78±0.02;屏-片成像术的AUC为0.74±0.02;P=0.18)
s322 Sentence This type of analysis was used in a meta-analysis of four of the five Swedish trials in response to concerns about the evaluation analyses 综上所述,出于对评估分析法的担忧,在对5项瑞典试验中的4项进行荟萃分析时,研究者选用了随访分析法
s323 Sentence Assuming an average sensitivity of 80%, mammograms will miss approximately 20% of the breast cancers that are present at the time of screening (false-negatives) 假设乳腺X线摄影的平均敏感性为80%,即筛查时会有约20%的乳腺癌病例被漏诊(假阴性事件)
s324 Sentence Intervention: Three single-view MMGs every 2 years for women younger than 50 years and every 33 months for women aged 50 years and older 试验组:年龄小于50岁的女性每2年进行一次单视图MMG;年龄大于50岁的女性每33个月进行一次单视图MMG,共3次
s325 Sentence During a 10-year period, 16% of 2,400 women aged 40 to 69 years sought medical attention for breast symptoms at their health maintenance organization 一项研究纳入了2,400例女性,年龄分布于40到69岁之间,其中10年间共有16%的女性因乳腺症状前往所属健康管理机构寻求医疗干预
s326 Sentence Food and Drug Administration (FDA) to ensure the use of standardized training for personnel and a standardized mammography technique utilizing a low radiation dose (具体信息参考FDA有关基于MQSA的乳腺X线摄影机构调查、乳腺X-线成设备评估和医师资格要求的网页)
s327 Sentence Several explanations for these findings have been proposed, including lower socioeconomic status, lower level of education, and less access to screening and treatment services 研究者为了解释这一结果提出了多种假说,包括社会经济状态更低、教育程度更低、更少有机会进行乳腺癌的筛查和治疗等
s328 Sentence For women younger than 50 years, all studies found sensitivity higher for digital mammography but specificity either the same or higher for film mammography 对于年龄小于50岁的女性,所有相关研究都显示数字乳腺X线摄影检查的敏感性更高,而特异性不低于应用乳腺屏-片X线检查
s329 Sentence In particular, mucinous, lobular, and rapidly growing cancers can be missed because their appearance on x-rays is similar to that of normal breast tissue 此外,粘液性、小叶性及快速生长的肿瘤,由于在X线上的表现类似正常乳腺结构,可能会在筛查中被遗漏
s330 Sentence Magnitude of Effect : Theoretically, annual mammograms in women aged 40 to 80 years may cause up to one breast cancer per 1,000 women  效应强度:理论上,对年龄在40至80岁间女性进行每年一次的乳腺X线摄影,会在每1000人中导致一例乳腺癌的发生
s331 Sentence Direct comparisons of breast MRI and mammography in young high-risk women report MRI sensitivities of 71% to100% versus mammography sensitivities of 20% to 50% 在年轻的乳腺癌高危女性中直接比较乳腺MRI与乳腺X线摄影,结果显示MRI和乳腺X线摄影的敏感性分别为71%-100%和20%-50%
s332 Sentence When all-cause mortality in these trials was examined retrospectively, only the Edinburgh Trial showed a significant difference, which could be attributed to socioeconomic differences 对上述临床试验的全因死亡率进行回顾性分析显示,只有爱丁堡试验具有组间显著差异,这可能归因于组间的社会经济学差异
s333 Sentence Overall sensitivity is approximately 79% but is lower in younger women and in those with dense breast tissue (see the BCSC Web site ) 就总体人群而言,敏感性约为79%;这一数值在年轻或乳腺组织致密的女性群体中要更低(详见BCSC网站)
s334 Sentence Comments: Concerns were raised about the randomization methodology and the evaluation analysis, which required a correction for late performance of the control group MMG 评论:关于随机分组及评估分析法尚有存疑,二者均需对对照组MMG的延迟时间予以校正
s335 Sentence In part to account for the effects of treatment, the third study was a detailed analysis by county and concluded little impact of screening 也正是由于考虑到治疗手段的干扰,第三项研究进行了十分细致的分析,并得出筛查有效性甚微的结论
s336 Sentence Numerous uncontrolled trials and retrospective series have documented the ability of mammography to diagnose small, early-stage breast cancers, which have a favorable clinical course 大量非对照临床试验及回顾性病例系列研究的结果已经显示乳腺X线摄影在诊断病灶较小的早期乳腺癌方面的优势,罹患病灶较小的早期乳腺癌的患者临床结局较为良好
s337 Sentence Exclusions: In a Swedish meta-analysis, there were 393 women with pre-existing breast cancer excluded from the intervention group, and 412 from the control group 排除标准:瑞典的一项荟萃分析从干预组和对照组中分别剔除了393例和412例既往患有乳腺癌的女性
s338 Sentence Relative risk of breast cancer death, screening versus control (95% confidence interval [CI]): 0.71 (0.55–0.93) at 10 years and 0.77 (0.61–0.97) at 15 years 乳腺癌相关死亡的相对危险度,筛查组与对照组相比(95%置信区间[CI]):随访10年时为0.71 (0.55-0.93) ;随访15年时为 0.77 (0.61-0.97)
s339 Sentence A sizable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit 患有晚期肿瘤的患者中很大一部分人会继续进行肿瘤筛查;而事实上这些检查似乎并不能带来有意义的获益
s340 Sentence Age differences have been identified in several trials, although the differences were probably too small to have a major effect on the trial outcome 在部分临床试验中,发现了年龄的组间差异,尽管在大多数研究中,这种差别大都微不足道,不足以影响整个试验结果
s341 Sentence Screening for breast cancer has been recommended for women exposed to therapeutic radiation to the chest, especially if they were exposed at an early age 对于胸部接受过治疗性射线暴露的女性,推荐进行乳腺癌筛查,特别是对于辐射暴露时年龄较小的女性
s342 Sentence Breast cancer mortality is the major outcome parameter for each of these trials, so the methods used to determine cause of death are critically important 乳腺癌死亡率是各项研究的主要结局指标,因此选取合适的方式判定死亡原因十分重要
s343 Sentence A U.S. ecologic analysis conducted between 1976 and 2008 examined the incidence of early-stage versus late-stage breast cancer for women aged 40 years and older 美国1976-2008年进行的一项生态学分析对大于等于40岁女性早期乳腺癌和晚期乳腺癌的发病率进行了研究
s344 Sentence To find a screening effect, the authors compared the magnitude of increase in early-stage cancer with the magnitude of an expected decrease in late-stage cancer 为了明确筛查对发病率的影响,研究者对早期肿瘤发病率的上升幅度,以及晚期肿瘤发病率的下降幅度进行了对比
s345 Sentence The authors suggested that improvements in breast cancer treatment and/or health care organizations were more likely responsible for the reduction in mortality than was screening 作者猜测乳腺癌治疗方式的进步及健康管理机构的发展,而非筛查,很可能才是导致乳腺癌相关死亡率下降的主要原因
s346 Sentence Obese women have more than a 20% increased risk of having false-positive mammography results compared with underweight and normal weight women, although sensitivity is unchanged 肥胖女性相比于低体重和正常体重的女性,乳腺X线摄影的敏感性相同,但假阳性率高了20%
s347 Sentence Abnormal cells were found in 92 (24%) ductal lavage samples, including 88 (17%) with mild atypia, 23 (6%) with marked atypia, and 1 (<1%) malignant 乳管灌洗液检查结果中,92例(24%)标本中发现了异常细胞,其中88例(17%)标本为轻度不典型增生,23例(6%)标本中出现严重不典型增生,而1例(<1%)标本为恶性
s348 Sentence On screening, the following Breast Imaging, Reporting and Data System (BI-RADS) assessments are used: 1, negative; 2, benign; or 0, incomplete with additional evaluation needed ​筛查时使用下述乳腺影像报告和数据系统(BI-RADS)分类法报告筛查结果:1,阴性;2,良性;0,不完全,需进行其他检查
s349 Sentence In the setting of normal mammography and ultrasonography, less than 3% of women who have a lump will ultimately be found to have breast cancer 在应用乳腺X线摄影及超声波检查的情况下,存在乳腺包块的女性中只有不到3%最终会被诊断为乳腺癌
s350 Sentence Annual screening with magnetic resonance imaging has been proposed in such women, beginning 8 years after treatment or by age 25 years, whichever is later 已有研究者提议此类患者在放射治疗8年后,应每年进行一次磁共振成像(MRI)的乳腺筛查;若8年后未满25岁,则改从25岁起
s351 Sentence Major concerns about trial performance are the validity of the initial randomization and the differential exclusion of women with a prior history of breast cancer 本试验存在的最主要问题在于以下两点:试验初期随机分组的可靠性、及组别间排除既往有乳腺癌病史的受试者时方式不同
s352 Sentence Hormone therapy is associated with increased breast density and is associated not only with lower sensitivity but also with an increased rate of interval cancers 激素疗法与腺体密度增高有关,其不仅与乳腺X线摄影敏感性下降相关,也与间期癌的发生率升高相关
s353 Sentence A way to view the potential benefit of breast cancer screening is to estimate the number of lives extended because of early breast cancer detection 由于乳腺癌筛查可以早期检出肿瘤,因此可以通过估算筛查延长患者寿命的情况观察乳腺癌筛查的潜在益处
s354 Sentence Thus, it may be estimated that up to one breast cancer may be induced per 1,000 women aged 40 to 80 years undergoing annual mammograms 理论上,对于年龄在40-80岁间的女性,如每年进行一次乳腺X线摄影的检查,每1000例这样的女性中会产生一例乳腺癌患者
s355 Sentence Several studies have shown that the method of cancer detection is a powerful predictor of patient outcome, which is useful for prognostication and treatment decisions 部分研究结果提示肿瘤检出方式是患者预后的一个强有力预测因素,对判断患者预后并决定治疗方式十分有用
s356 Sentence Screening mammography in women older than 65 years often results in additional diagnostic testing in 85 per 1,000 women, with cancer diagnosed in 9 women 每1,000例年龄大于65岁的女性接受乳腺钼靶筛查,有85例女性会继续接受额外的诊断检查,其中9例最终被诊断为癌症
s357 Sentence After controlling for tumor size, nodal status, grade, and patient age, researchers found that the women with screen-detected cancers fared better than their symptomatic counterparts 在控制肿瘤大小、淋巴结情况、肿瘤级别、患者年龄等变量后,研究者发现与症状检出乳腺癌患者对比,筛查检出的乳腺癌患者生存有获益
s358 Sentence Because the extent of these biases is never clear in any particular study, most groups rely on randomized controlled trials to assess the benefits of screening 对于任何一项专业研究而言,上述偏倚的严重程度都无法明确;因此,多数组织选择进行随机对照临床试验以评估筛查的疗效
s359 Sentence One large population-based study comparing recall rates and breast cancer detection rates before and after the introduction of CAD systems found no change in either rate 一项基于人群的大型研究对比了引入CAD系统前后,筛查召回率及乳腺癌检出率的差异,而结果显示并无差别
s360 Sentence Again, the cancer detection rate was not different between FFDM (4.9 per 1,000) and SFM (4.8 per 1,000), although the recall rate was higher for FFDM 同样,结果显示虽然FFDM组的召回率较高,但FFDM组和SFM组的肿瘤检出率分别为每1,000例中检出4.9例和4.8例,并无差别
s361 Sentence Conclusions: Delay in the performance of MMG in the control group and unequal numbers of women in invited and control groups (complex randomization process) complicates interpretation 结论:以下两大因素干扰了试验结果的判读:对照组MMG筛查时间延迟;对照组及试验组受试者人数的不均等(随机分组过程复杂)
s362 Sentence Two-view examinations are associated with a lower recall rate than are single-view examinations because they eliminate concern about abnormalities due to superimposition of normal breast structures 此外,与单体位筛查技术相比,双体位筛查技术与更低的病人召回率相关;这是因为双体位筛查技术可以消除正常乳腺组织重叠引起的假性异常所致的疑虑
s363 Sentence Breast cancer incidence overall was 4.4%, including 11 cases of DCIS and 93 cases of invasive cancer, and was associated with abnormal nipple aspirate fluid cytology 结果显示乳腺癌的总体发病率为4.4%,其中包括11例DCIS和93例浸润性乳腺癌;且这一结果与异常的乳头抽吸液细胞学结果有关
s364 Sentence Nipple aspirate fluid cytology was studied in 2,701 women who were monitored for subsequent incidence of breast cancer, with an average of 12.7 years of follow-up 研究者在2,701例女性中进行乳头抽吸液细胞学研究,并观察后续乳腺癌的发病率,其平均随访时间为12.7年
s365 Sentence The investigators found that each country had experienced a reduction in breast cancer mortality, with no difference between matched pairs that could be attributed to screening 研究者发现每个城市都出现了乳腺癌相关死亡率的下降,配对的组间没有因筛查与否而存在差异
s366 Sentence Random periareolar fine-needle aspirates were performed in 480 women at high risk for breast cancer, and the women were monitored for a median of 45 months 480例乳腺癌高危女性接受了随机环乳晕细针抽吸活检术,并在术后接受了中位期为45个月的观察
s367 Sentence Even though breast cancer is the most common noncutaneous cancer in women, fewer than 5 per 1,000 women actually have the disease when they are screened 尽管乳腺癌是女性最为常见的非表皮肿瘤,但筛查数据显示没1000名女性中只有不到5例乳腺癌患者
s368 Sentence The low-risk group, comprising a third of the cases, experienced only 1% DCIS recurrences and no invasive cancers, independent of the use of postoperative radiation therapy 在上述病例中,低危组占到了三分之一, DCIS复发风险只有1%,且没有进展为浸润癌的病例;该结果与是否行术后放疗无关
s369 Sentence Thus, it is not possible to assess the efficacy of CBE as a screening modality when it is used alone versus usual care (no screening activity) 因此,暂时不太可能将CBE作为一项单独的筛查手段,与常规护理(即不进行任何筛查检查)对比并评价其有效性
s370 Sentence During that period, one-third of the women had an abnormal mammogram result that required additional testing, including 539 additional mammograms, 186 ultrasound examinations, and 188 biopsies 在研究期间,三分之一的女性曾经出现了异常乳腺X-线检查结果,并进行了进一步的检查,其中包括539例乳腺钼靶检查复查、186例超声检查及188例活检
s371 Sentence For 25,620 women aged 40 to 49 years who were examined only at entry, the estimated sensitivity was 71%, specificity was 84%, and PPV was 1.5% 而对于25,620例年龄在40-49岁的女性,研究者只在试验入组时对其CBE结果进行评估,显示敏感性为71%,特异性为84%,而PPV为1.5%
s372 Sentence While the numbers discussed above are from a single mammography exam, women undergo screening throughout their lifetimes, which can include 20 to 30 years of screening activity 上述数字主要针对单次乳腺X线摄影,而女性在一生中可能接受乳腺癌筛查的时间约为20-30年
s373 Sentence After controlling for patient and radiologist characteristics, screening mammography interpretive performance (specificity, PPV, area under the curve [AUC]) varies by facility and is associated with facility-level characteristics 在控制患者特征及医师特征后,乳腺X线摄影能否能高效地筛查出肿瘤(特异性、PPV及曲线下面积[AUC])还取决于筛查机构,并与机构特征息息相关
s374 Sentence The likelihood of diagnosing cancer is highest with the prevalent (first) screening examination, ranging from 9 to 26 cancers per 1,000 screens, depending on the woman’s age 初次(第一次)行筛查检查发现乳腺癌的可能性最大。根据受检女性年龄不同,每1000例筛查女性中可检出9-26例乳腺癌
s375 Sentence Initiating biennial screening at age 40 years (vs. age 50 years) reduced breast cancer mortality by an additional 3%, consumed more resources, and yielded more false-positive results 如果从40岁起(与50岁起对比)开始每2年进行一次筛查,乳腺癌相关死亡率可多下降3%;但这种方案会消耗更多资源,产生更多的假阳性事件
s376 Sentence Using infrared imaging techniques, thermography of the breast identifies temperature changes in the skin as an indicator of an underlying tumor, displaying these changes in color patterns 依靠红外线成像技术,乳腺热像图将皮肤的温度变化作为潜在肿瘤提示,并将这些温度变化以不同的颜色图案表示
s377 Sentence The study women were older than the control women, P &lt; .0001, but this should not have had a major effect on the outcome of the trial 试验组女性受试者的年龄大于对照组(P<0.0001),但这种差别对研究结果并无较大影响
s378 Sentence These models gave reductions in breast cancer mortality similar to those expected in the circumstances of the RCTs but updated to the use of modern adjuvant therapy 这些模型所得出的乳腺癌相关死亡率的下降与RCT研究设置所得出的结果相似;但相比于RCT,建模研究还添加了先进的辅助性治疗方案
s379 Sentence Note: Separate PDQ summaries on Breast Cancer Prevention , Breast Cancer Treatment , Male Breast Cancer Treatment , and Breast Cancer Treatment and Pregnancy are also available 注:关于乳腺癌的其他总结,见乳腺癌的预防、乳腺癌的治疗、男性乳腺癌的治疗、乳腺癌的治疗与妊娠​
s380 Sentence Exclusions: Small (n = 30 in invited group and n = 51 in not invited group) number excluded in each group because could not locate or deceased 排除:两组均将不能确定地点或已故的受试者排除,但数目均偏小(试验组和对照组分别为30例和51例)
s381 Sentence Strategies have been proposed to improve mammographic sensitivity by altering diet, timing mammograms with menstrual cycles, interrupting hormone therapy before the examination, or using digital mammography machines 为了提高乳腺X线摄影的敏感性,研究者提出以上方案:改变饮食习惯、根据月经周期行乳腺筛查、在检查前中止激素疗法、以及应用数字化X线成像仪器
s382 Sentence Breast cancer stage at diagnosis in San Diego County, California, was more advanced for Hispanic women than for white women, especially for those younger than 50 years 在加利福尼亚州圣地亚哥市,西班牙裔女性检出的乳腺癌肿瘤期别明显晚于白人女性,尤其对于年龄小于50岁的女性而言
s383 Sentence Screening women in their 80s and 90s should be performed on a case-by-case basis, with comorbid diseases and life expectancy taken into consideration when making this decision 80多岁和90多岁的女性接受筛查应按个体化原则进行,是否筛查需考虑到合并症和预期寿命
s384 Sentence For example, if a model’s output agrees with RCT outcomes for annual screening, then it has greater credibility in comparing the relative effectiveness of biennial versus annual screening 比如,如果一个模型的输出结果与年度筛查RCT的结果相符时,该模型被用于比较两年一次和每年一次筛查组的相对有效性时,其可信度也较高
s385 Sentence Screen-detected cancers were more likely to have tubular histology; to be smaller, low stage, and hormone sensitive; and to have a major component of ductal carcinoma in situ 而筛查诊断的肿瘤往往具有以下特征:多为导管来源、体积更小、低级别及激素敏感;其中很大一部分为导管原位癌
s386 Sentence However, a subsequent study comparing Nijmegen breast cancer mortality rates with neighboring Arnhem in the Netherlands, which had no screening program, showed no difference in breast cancer mortality 然而,另一项后续的研究将奈梅亨的乳腺癌相关死亡率数据与相邻城市阿纳姆对比,二者的乳腺癌相关死亡率并无差别,而阿纳姆市并未开展筛查项目
s387 Sentence To determine the number of screen-detected cancers that are overdiagnosed, one can compare breast cancer incidence over time in a screened population with that of an unscreened population ​为了明确筛查检出的肿瘤中被过度诊断的病例数,研究者可以将筛查群体在一段时间内的乳腺癌发病率与未进行筛查的群体进行对比
s388 Sentence In particular, the detection of a low-risk malignancy would probably result in a recommendation for treatment, which could impair rather than improve quality of life, without improving survival 特别是当筛查手段检出低危恶性肿瘤时,很可能会建议患者进行治疗,而结果不仅不能提高生活质量和生存率,反而可能影响生活质量
s389 Sentence As shown in Table 1, a 60-year-old woman has a higher risk of being diagnosed with breast cancer in the next 10 years than does a 40-year-old woman 如表1所示,一名60岁的女性在未来10年内被诊断为乳腺癌的风险要高于40岁的女性
s390 Sentence In New Mexico, a population-based case-control study examined the reproductive histories of 719 Hispanic and 836 white breast cancer patients, with half of each group having breast cancer 在新墨西哥,一项基于人群的病例对照研究有719例西班牙裔女性和836例白人女性入组,该研究对她们的生育史进行回顾;其中各组中均有半数受试者患有乳腺癌
s391 Sentence Interval cancers appearing within 12 months of a negative screening mammogram appear to be related to decreased mammographic sensitivity, attributable to greater breast density in 68% of cases 乳腺X线筛查显示阴性后12个月内发生的间期癌被认为可能与乳腺X线摄影敏感性低有关;在68%的病例中这被归因于乳腺腺体致密
s392 Sentence There were two subtrials with balanced randomization in the first and a significant imbalance in the second with 508 more women in the screened group than the control 本试验分为两个亚试验,其中第一个亚试验的分组保持平衡,而第二个亚试验的分组存在严重不平衡,筛查组受试者人数比对照组多508例
s393 Sentence Second, in the U.K. Trial of Early Detection of Breast Cancer, two districts invited more than 63,500 women aged 45 to 64 years to educational sessions about BSE 第二项研究是英国针对乳腺癌早期检出的临床试验,该研究在两个地区共招募63,500例45-64岁女性受试者,并对受试者进行BSE相关教育课程
s394 Sentence Overdiagnosis bias: An extreme form of length bias; screening may find cancers that are very slow growing and would never have become manifest clinically in the woman’s lifetime ​过度诊断偏倚:这是病程偏倚的一种极端状态;筛查可能会发现生长极为缓慢的肿瘤类型,这些肿瘤甚至在患者有生之年都不会存在任何临床表现
s395 Sentence In a random-effects model, there was no statistically significant difference in cancer detection between the two types of mammography (AUC 0.92 for film and AUC 0.91 for digital) 随机效应模型分析显示两种不同的筛查手段在肿瘤检出率方面并无统计学意义的差别(屏-片组的AUC为0.92,而数字组的AUC为0.91)
s396 Sentence When results were recalculated in the Swedish meta-analysis, using data from the Swedish Cause of Death Registry, there was less benefit for screening than had been previously reported 瑞典荟萃分析使用瑞典死亡原因登记处的信息,重新统计试验结果,并与既往的研究结果进行对比,比较显示筛查的优势弱于之前所报道的
s397 Sentence In the United States, the mean glandular dose for screening mammography is 1 to 2 mSv per view or 2 mSv to 4 mSv per standard two-view exam 在美国,乳腺X线摄影筛查对乳腺腺体造成的平均辐射剂量在单体位检查为1-2 mSv,而双体位检查中为2-4 mSv
s398 Sentence Digital mammography was better at cancer detection for women younger than 50 years (AUC 0.84 +/- 0.03 for digital; AUC 0.69 +/- 0.05 for film; P = .002) 在年龄小于50岁的女性中,数字乳腺X线摄影对乳腺癌的检出更佳(数字成像术的AUC为0.84±0.03;屏-片成像术的AUC为0.69±0.05;P=0.002)
s399 Sentence Randomized controlled trials (RCTs), with participation by nearly half a million women from four countries, examined the breast cancer mortality rates of women who were offered regular screening 为了获取接受常规筛查的女性中乳腺癌死亡率的数据,研究者开展了多项随机对照临床试验(RCT),共收入了来自四个国家的近50万例女性受试者
s400 Sentence Of the breast symptoms prompting medical attention, a mass was most likely to lead to a cancer diagnosis (10.7%) and pain was least likely (1.8%) to do so 而在所有促使女性寻求医疗干预的乳房症状中,肿物最有可能导致乳腺癌诊断(10.7%),而疼痛则最不可能(1.8%)
s401 Sentence This difference in methodology has the potential for a substantial bias in comparing breast cancer mortality between the two groups, and this bias is likely to favor screening 当对比两组乳腺癌相关死亡率的数据时,上述试验方法间的差别很可能会产生实质性的偏倚,而这个偏倚往往会偏向于筛查组更优
s402 Sentence One author estimated the outcomes of 10,000 women aged 50 to 70 years who undergo a single screen. Mammograms will be normal (true-negatives and false-negatives) in 9,500 women 根据一位作者估算,10,000例年龄在50到70岁间接受筛查的女性中,9,500例女性的乳腺X线摄影的结果正常(包括真阴性和假阴性)
s403 Sentence In Nijmegen, the Netherlands, where a population-based screening program was undertaken in 1975, a case-cohort study showed that screened women have decreased mortality (odds ratio [OR] = 0.48) 1975年,荷兰的奈梅亨市在开展了一项基于人群的筛查项目,这一病例队列研究显示筛查女性的死亡率下降(比值比[OR] 0.48)
s404 Sentence The specificity of mammography (refer to the Breast Cancer Screening Concepts section of this summary for more information) affects the number of additional interventions due to false-positive results 乳腺钼靶检查的特异性(更多信息参见本总结乳腺癌的筛查概念 一节)反映了假阳性事件的发生率,因此会影响额外干预的数量
s405 Sentence This trial and NBSS-2 differ from the other RCTs in the consistent use of adjuvant hormone and chemotherapy following local breast cancer therapy in women with axillary node-positive disease 本试验和NBSS-2试验与其他RCT之间的差别在于,对于已有腋窝淋巴结阳性的患者,在局部乳腺癌治疗后前两项试验均使用了激素辅助治疗和化疗
s406 Sentence The primary deficiency identified by this review was the use of the mediolateral view from 1980 to 1985 instead of the mediolateral oblique view, which was used after 1985 审核结果显示1980年到1985年间,研究应用的MMG为内外侧视图,而在1985年后,研究采用的MMG确是内外侧斜位视图
s407 Sentence About 2% of women screened will be recommended for short-interval follow-up, assessed as BI-RADS 3, probably benign, with fewer than 2% of such women ultimately found to have cancer 在所有筛查女性中,约有2%被评估为BI-RADS 3类,即很可能为良性,并被建议接受短期随访,其中少于2%女性最终发现癌症
s408 Sentence For example, among women with advanced cancer compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%–9.1%) versus 22.0% (95% CI, 21.7%–22.5%) 例如,患晚期肿瘤的患者与对照者相比,至少进行一次乳腺钼靶筛查的比例为8.9%(95%置信区间[CI],8.6%-9.1%),而对照组为22.0%(95%CI,21.7%-22.5%)
s409 Sentence A “perfect” screening test would identify approximately 10% of “normal” women as having breast cancer, even though most of those cancers would probably not result in illness or death 所谓的“完美”筛查会将约10%的“正常”女性诊断为乳腺癌,尽管其中的大部分肿瘤很可能并不会导致疾病或死亡
s410 Sentence The best evidence indicates that most DCIS lesions will not evolve to invasive cancer and that those that do can still usually be managed successfully, even after that transition 这一证据说明了大多数DCIS病灶不会进展为浸润性癌,而少数进展为浸润性癌的DCIS病例即使在进展后,仍然可以被成功治疗
s411 Sentence A community-based case-control study of screening as practiced in excellent U.S. health care systems between 1983 and 1998 found no association between previous screening and reduced breast cancer mortality 另一项基于社区的病例对照研究在1983至1998年间进行,按照先进的美国健康管理系统进行乳腺癌的筛查研究,结果显示既往筛查史与乳腺癌相关死亡率下降并无关联
s412 Sentence Women with a personal history of invasive breast cancer, DCIS, or lobular carcinoma in situ also have an increased risk of being diagnosed with a new primary breast cancer 曾经罹患浸润性乳腺癌、DCIS或小叶原位癌的女性,其被诊断新发原发乳腺癌的风险也会增加
s413 Sentence A large cohort of women (n = 42,760) who underwent both digital and film mammography was evaluated at 33 U.S. centers in the Digital Mammographic Imaging Screening Trial (DMIST) 数字乳腺X线摄影筛查临床试验(DMIST)是一项大型队列研究,共纳入42,760例女性,分别在美国的33个研究中心进行乳腺数字或屏-片X线检查
s414 Sentence Delay in diagnosis of breast cancer is the most common cause of medical malpractice litigation and half of the cases resulting in payment to the claimant involve false-negative mammograms 乳腺癌诊断的延误是导致医疗诉讼最为常见的原因,在以赔偿原告告终的案例中,有半数都与乳腺X线摄影的假阴性结果有关
s415 Sentence Those appearing within a 24-month interval appear to be related both to decreased mammographic sensitivity due to greater breast density in 37.6% and to rapid tumor growth in 30.6% 而在24个月内发生的间期癌则被认为与乳腺致密引起的乳腺X线摄影敏感性低(见于37.6%的病例)和肿瘤生长快速(见于30.6%的病例)都有关系
s416 Sentence A Finnish study of 14,765 women aged 40 to 49 years assigned women born in even-numbered years to annual screens and women born in odd-numbered years to triennial screens 一项芬兰研究收录了年龄在40到49岁之间的14,765例女性,将这些女性分为两组:偶数年出生的女性每年进行一次筛查,奇数年出生的女性每三年进行一次筛查
s417 Sentence Comparisons across counties showed similar reductions in decreased breast cancer mortality regardless of when the counties’ screening programs were initiated; however, the authors carried out no formal cross-county analyses 对比不同城市的研究结果显示不管该城市何时开启筛查项目,都能引起乳腺癌相关死亡率相似的下降;但是,研究者并没有进行不同城市间的对比分析
s418 Sentence Randomization: Individual, but with significant imbalances in the distribution of women between assigned arms, as evidenced by menopausal status ( P &lt; .0001) and education ( P = .05) 随机分组:个体随机分组,但在不同组别间存在严重不平衡,包括绝经状态(P<0.0001)和教育程度(P=0.05)
s419 Sentence Survival in black women may be worse than in white women at least in part because of a higher frequency of adverse histologic features, such as a triple-negative phenotype 黑人女性的乳腺癌生存状况可能比白人女性更差,至少部分是因为黑人女性的乳腺癌出现恶性组织学特征的比例更高,例如三阴性表型
s420 Sentence In an overview of seven autopsy studies, the median prevalence of occult invasive breast cancer was 1.3% (range, 0%–1.8%) and of ductal carcinoma in situ was 8.9% (range, 0%–14.7%) 对七项尸检研究进行总结,分析结果显示隐性浸润性乳腺癌的中位患病率为1.3%(范围,0%-1.8%),而导管内原位癌的中位患病率为8.9%(范围,0%-14.7%)
s421 Sentence To make these adjustments, the authors made uncertain assumptions about the effects of other factors on incidence, and made no mention of the effects of changing treatment over time 但在进行上述调整时,对于其他不确定因素对发病率的影响,研究者只给出了不确定的猜测;而对于研究期间治疗手段发展对发病率的影响,研究者并未提及
s422 Sentence Population-based studies demonstrate that, compared with other groups, Medicaid recipients and uninsured patients of all races have later-stage breast cancer diagnosis, and survival from the time of diagnosis is shorter 一项基于人群的研究结果显示,所有种族的美国医疗补助计划的受助者及无保险患者相比于其他人群而言,诊断乳腺癌时分期更晚,且自诊断起生存时间也更短
s423 Sentence The trials differed in design, recruitment of participants, interventions (both screening and treatment), management of the control group, compliance with assignment to screening and control groups, and analysis of outcomes 各项临床试验在试验设计、受试者的招募、干预方式(包括筛查和治疗手段)、对照组的处理、筛查组及对照组的分配方式以及对结果的评估等方面各异
s424 Sentence Women with abnormal screening mammograms undergo additional mammographic imaging to magnify the area of concern, ultrasound, magnetic resonance imaging, and tissue sampling (by fine-needle aspiration, core biopsy, or excisional biopsy) 乳腺钼靶检查筛查结果为异常的女性通常需要进行更多的乳腺相关影像检查以放大所关注的区域;进一步的检查方式包括超声、磁共振成像及组织活检(细针抽吸活检、粗针活检或切除活检等)
s425 Sentence All of these studies are designed to study breast cancer mortality rather than all-cause mortality because of the infrequency of breast cancer deaths relative to the total number of deaths 乳腺癌所致死亡病例仅占全因死亡病例的很少一部分,因此所有试验设计都是研究乳腺癌相关死亡率,而非全因死亡率
s426 Sentence Early cancer detection and prompt treatment are unlikely to reduce morbidity or mortality within a woman's 5 years of expected survival, but the negative consequences of screening will occur immediately 在短短5年的预期寿命内,早期检出肿瘤并治疗不仅不太可能减低发病率和死亡率,筛查所引起的负面反应却会立即出现
s427 Sentence When a control patient died and her cause of death was determined to be breast cancer, a retrospective examination was made to determine the date of diagnosis of her disease 所以如果对照组的受试者最终死于乳腺癌,研究者需要进行回顾性研究以确定疾病诊断的具体日期
s428 Sentence Cause of death attribution: Women who died of breast cancer that had been diagnosed before entry into the study were excluded from the comparison between the screening and control groups 死亡原因分析:如果受试女性在入组前即被诊断为乳腺癌,且在试验过程中死于乳腺癌,这样的受试者将不被纳入筛查组与对照组的对比
s429 Sentence Younger women have lower sensitivity and higher false-positive rates on screening mammography than do older women (refer to the Breast Cancer Surveillance Consortium performance measures by age for more information) 使用乳腺X线摄影进行筛查时,较年轻女性相比于较老龄女性,其敏感性较低,假阳性率增高(更多信息参见乳腺癌监管联合会中年龄对影像学结果的影响一节)
s430 Sentence Because ductal lavage screening has not been compared to mammography and there is no evidence of efficacy or mortality reduction, its use as a screening or diagnostic tool remains investigational 但是,由于乳管灌洗筛查未曾与乳腺X线摄影进行比较,并且暂无证据提示乳管灌洗术作为筛查手段,可以改善疗效和死亡率,因此,是否将乳管灌洗术用做筛查或诊断手段尚在研究之中
s431 Sentence Clinical breast examination (CBE) has not been tested independently; it was used in conjunction with mammography in one Canadian trial, and was the comparator modality versus mammography in another trial 目前现有的研究并未将临床乳腺检查(CBE)单独用于评估,多与其他检查一同进行研究;如一项加拿大的临床试验评估了乳腺X线摄影与CBE的联合应用,而其他临床试验则将其与乳腺X线摄影进行对比
s432 Sentence For women older than 40 years, the benefits of annual mammograms probably outweigh the potential risk, but certain subpopulations of women may have an inherited susceptibility to ionizing radiation damage 对于大于40岁的女性,每年进行一次乳腺X线摄影所带来的益处,极可能已远远超过其潜在的风险,但是某些女性因遗传易感性可能会更易出现电离辐射损伤
s433 Sentence Using multiple logistic regression and Cox proportional hazards analysis, a diagnosis of hyperplasia with atypia was found to be associated with the subsequent development of DCIS and invasive breast cancer 使用多元回归分析和Cox比例风险分析,结果显示,不典型增生的诊断与患者后续发展为DCIS和浸润性乳腺癌相关
s434 Sentence After 10 years of follow-up, there was no difference in breast cancer mortality rates compared to those in women from centers without organized BSE education (RR = 1.07; 95% CI, 0.93–1.22) 经过10年的随访,并与其他研究中心未接受系统化BSE培训的女性受试者对比,结果显示两组间乳腺癌相关死亡率并无差别(RR,1.07;95%CI,0.93-1.22)
s435 Sentence High breast density is an inherent trait, which can be familial but also may be affected by age, endogenous and exogenous hormones, selective estrogen receptor modulators such as tamoxifen, and diet 腺体密度高是一项遗传特性,通常表现为家族性特性;但也会受到其他多种因素影响,包括年龄、内源性 及外源性激素、选择性雌激素受体调节剂如他莫昔芬、及饮食等
s436 Sentence Breast cancer mortality with follow-up 11 to 16 years after entry (mean = 13 years) was similar in the two screening arms (mortality rate ratio, 1.02 [95% confidence interval [CI], 0.78–1.33]) 此外,本试验在受试者入组后对受试者进行了11-16年(平均13年)的随访,结果显示两组的乳腺癌相关死亡率并无差异(死亡率比值比为1.02[95%置信区间[CI]为0.78-1.33])
s437 Sentence One large randomized trial found that 13.4% of women treated by lumpectomy alone developed ipsilateral invasive breast cancer within 90 months, compared with 3.9% of those treated by lumpectomy and radiation 一项大型随机临床试验发现,仅接受肿物局部切除术的DCIS患者中,13.4%在90个月内发展为同侧浸润性乳腺癌;而这一数值在联合应用乳腺肿瘤局部切除术及放疗的DCIS患者中,仅为3.9%
s438 Sentence Sensitivity depends on tumor size, conspicuity, and hormone sensitivity as well as breast tissue density, patient age, timing within the menstrual cycle, overall image quality, and interpretive skill of the radiologist 敏感性的高低取决于多种因素,包括肿瘤的大小、可触及度、激素敏感性、乳腺组织密度、患者年龄、筛查时间与月经周期的关系、总体影像质量以及影像科医师解读影像资料的能力
s439 Sentence Compared with surgical needle localization under x-ray guidance, core needle biopsy resulted in fewer surgical procedures for definitive treatment, with a higher likelihood of clear surgical margins at the initial excision 相比于X-线导引下细针定位手术活检,粗针穿刺活检导致最终手术步骤更少,且切缘干净的可能性更高
s440 Sentence The initial analysis of these trials used an "evaluation" analysis, tallying only the breast cancer deaths that occurred in women whose cancer was discovered at or before the last study mammogram 这些试验最初均采用“评估”分析,仅分析截至最后一次乳腺筛查检查及之前发现乳腺癌的女性的乳腺癌死亡率
s441 Sentence In the last decade, women have refrained from using postmenopausal hormones, and breast cancer incidence has declined, but not to the levels seen prior to the widespread use of screening mammography 在过去十年间,女性在应用绝经后激素治疗方面有所节制,因此乳腺癌发病率有所下降,但尚未降至广泛应用筛查性乳腺X线摄影之前的水平
s442 Sentence One study that evaluated how often pain and discomfort are felt during mammography reported that 90% of women undergoing mammography had discomfort, and 12% rated the sensation as intense or intolerable 一项研究评估乳腺X线摄影中疼痛及不适感发生率,结果显示90%的女性在检查过程中有不适感,而12%的女性将这种感觉描述为强烈或不可耐受
s443 Sentence One study compared two adjacent time periods in 7 of the 25 counties in Sweden and concluded a statistically significant breast cancer mortality reduction of 18% to 32% attributable to screening 其中一项研究在瑞典25个乡镇中7个乡镇开展,主要对比了两个相邻的时间段内上述数值的差别,结果显示实施筛查项目后乳腺癌相关死亡率较无筛查项目的对照组下降了18%-32%,且在统计学上亦有显著差异
s444 Sentence Several characteristics of women being screened that are associated with the accuracy of mammography include age, breast density, whether it is the first or subsequent exam, and time since last mammogram 与乳腺X线摄影准确性相关的女性特征包括:年龄、腺体密度、是否初次行乳腺X线摄影以及距离上次乳腺X线摄影的时间
s445 Sentence The specificity of mammography is the likelihood of the test being normal when cancer is absent, whereas the false-positive rate is the likelihood of the test being abnormal when cancer is absent 乳腺X线摄影的特异性指对于不存在肿瘤的患者,检查结果为正常的概率;反之,假阳性率即指对于不存在肿瘤的患者,检查结果为异常的概率
s446 Sentence Radiation-Induced Breast Cancer : Radiation-induced mutations can cause breast cancer, especially if exposure occurs before age 30 years and is at high doses, such as from mantle radiation therapy for Hodgkin disease 射线诱发的乳腺癌: 射线诱发突变可以导致乳腺癌产生,特别是在30岁前有射线暴露且辐射剂量较高时,如霍奇金疾病的斗篷式放疗
s447 Sentence Women treated with thoracic radiation before the age of 30 years have a 1% annual risk of breast cancer, starting 8 years after the irradiation and for the rest of their lives 30岁前接受胸部放疗的女性,在距放疗8年后乳腺癌的年发病率为1%,且终生如此
s448 Sentence Over the study period, the absolute increase in the incidence of early-stage cancer was 122 cancers per 100,000 women, while the absolute decrease in late-stage cancers was 8 cases per 100,000 women 研究期间,在每100,000名女性受试者中,早期肿瘤检出例数绝对增加122例,而晚期肿瘤检出例数绝对减少8例
s449 Sentence This favorable outcome may reflect the benign nature of the condition, the benefits of treatment, or the volunteer effect (women undergoing breast cancer screening are generally healthier than those who do not) 这一有利结果可能反映出DCIS的良性性质、治疗有效性或自愿效应(即进行乳腺癌筛查的女性普遍比不进行筛查的女性更健康)
s450 Sentence Many of these missed cancers are high risk, with adverse biologic characteristics (refer to the Interval cancers section in the Breast Cancer Screening Concepts section of this summary for more information ) 这些被漏诊的肿瘤多数为高危型,伴恶性的生物学特征(更多信息参见本份总结中乳腺癌的筛查概念中的间期癌一节)
s451 Sentence A study of breast cancer screening in 2,400 women enrolled in a health maintenance organization found that over a 10-year period, 88 cancers were diagnosed, 58 of which were identified by mammography 一项乳腺癌筛查研究收录了健康管理结构的2,400例女性,在10年间诊断出88例乳腺癌;其中58例由乳腺钼靶检查诊断
s452 Sentence A population-based study showed increases in invasive breast cancer incidence of 54% in Norway and 45% in Sweden in women aged 50 to 69 years, following the introduction of nationwide screening programs 另一项基于人群的研究亦显示,随着筛查系统在全国范围的推进,对于挪威50到69岁的女性群体,其浸润性乳腺癌的发病率上升54%,而瑞典则为45%
s453 Sentence There was a trend in favor of screening, but again, the authors did not consider the effect of adjuvant therapy or differences in geography (urban vs. rural) that might affect treatment practices 研究结果亦偏向于筛查有利的方面,然而同样遗憾的是,研究者并未考虑过辅助治疗手段的影响,亦未排除地理因素的差异(城镇对比乡村)对治疗手段的影响
s454 Sentence Some trials used individual randomization, while others used cluster randomization in which cohorts were identified and then offered screening; one trial used nonrandomized allocation by day of birth in any given month 一些临床试验采取个体随机分组方案,而另一些则使用整群随机分组方式产生不同队列并完成筛查。此外,尚有一项临床试验根据受试者的出生日非随机分组,且不考虑出生月份
s455 Sentence Although criticisms of the randomization procedure have been made, a thorough independent review found no evidence of subversion and that subversion on a scale large enough to affect the results was unlikely 尽管有人对试验的随机分组过程提出质疑,针对该过程的完全独立回顾分析却显示,尚无证据证明分组过程中出现分组错乱,即便有,分组错乱的数量也不太可能会影响到试验结果
s456 Sentence By reviewing Medicare claims following mammographic screening in 23,172 women older than 65 years, one study found that, per 1,000 women, 85 had follow-up testing, 23 had biopsies, and 7 had cancer 根据医疗保险制度要求,23,172例大于65岁的女性接受了乳腺钼靶筛查。一项研究通过分析上述结果发现,在每1,000例接受筛查的女性中,85例进行了随访检查,23例接受活检,7例被诊断为乳腺癌
s457 Sentence Breast cancer is the most common noncutaneous cancer in U.S. women, with an estimated 62,570 cases of in situ disease, 232,670 new cases of invasive disease, and 40,000 deaths expected in 2014 ​乳腺癌是美国女性最常见的非表皮性肿瘤,预计2014年原位癌病例约为62,570例,新发浸润性癌病例为232,670例,死亡病例数为40,000例
s458 Sentence For women whose cancers were detected outside screening, the hazard ratio (HR) for death was 1.90 (95% confidence interval [CI], 1.15–3.11), even though they were more likely to receive adjuvant systemic therapy 对于非筛查检出的肿瘤,即使更有可能接受辅助性全身疗法,其死亡风险比仍高达1.90(95%置信区间[CI]为1.15-3.11)
s459 Sentence Concerns were expressed prior to completion of the trial about the technical adequacy of the MMGs, the training of the radiologists, and the standardization of the equipment, which prompted an independent external review 试验结束前研究者对多个环节产生顾虑,包括MMG技术的充分性、影像科医师的培训以及设备的标准化等,因此需要进行独立的外部审核
s460 Sentence After 10 to 11 years of follow-up, 135 breast cancer deaths occurred in the instruction group, and 131 cancer deaths occurred in the control group (relative risk [RR] = 1.04; 95% CI, 0.82–1.33) 持续10-11年的随访结果显示, 进行BSE的一组中共有135例乳腺癌相关死亡病例;而对照组则为131例(相对危险比[RR]为1.04;95%CI,0.82-1.33)
s461 Sentence If there were no overdiagnosis—and other aspects of screening were unchanged—there would be a rise in incidence followed by a decrease to below the prescreening level, and the cumulative incidence would be similar 假设不存在过度诊断,且筛查过程的其他方面均保持不变的话,随着筛查手段的广泛应用,乳腺癌的发病率将会首先上升,随后下降至低于筛查前水平,而总发病率则基本保持不变
s462 Sentence In some of the trials a delay occurred in the performance of the end-of-study mammogram, resulting in more time for members of the control group to develop or be diagnosed with breast cancer 在一些研究中,最后一次乳腺筛查检查出现了不可控的延迟,在这段时间里,对照组又有一部分受试者新发或被诊断为乳腺癌
s463 Sentence Widespread adoption of screening increases breast cancer incidence in a given population and changes the characteristics of cancers detected, with increased incidence of lower-risk cancers, premalignant lesions, and ductal carcinoma in situ (DCIS) 筛查手段的广泛应用一方面提高了某些人群的乳腺癌发病率,另一方面改变了肿瘤的统计学特征,即低级别肿瘤、癌前病变及导管内原位癌(DCIS)的发病率增加
s464 Sentence A single retrospective review of 11,760 breast biopsies performed between 1952 and 1968 identified 28 cases of DCIS, which were detected by physical examination, biopsied without resection, and then followed for 30 years 一项回顾性研究收入了1952年至1968年间进行的11,760例乳腺癌活检病例,共发现28例DCIS。这些病例均由体检发现,除进行活检明确诊断外并未行病灶切除,且在诊断后进行了长达30年的随访
s465 Sentence In the United States, only 4,900 women were diagnosed with DCIS in 1983, compared with approximately 64,000 women who are expected to be diagnosed in 2013, when mammographic screening has been widely adopted 在美国,1983年仅有4,900例女性被诊断为DCIS;而在2013年,随着乳腺X线摄影筛查的广泛应用,预计这一数值将达到将近64,000例
s466 Sentence A study of a single-center population-based screening program in the Netherlands compared women aged 50 to 75 years screened by full-field digital mammography (FFDM) that included computer-aided detection (CAD) with women screened by SFM 一项荷兰单中心人群筛查项目比较了50-75岁女性接受全视野数字乳腺X线摄影检查(FFDM)的结果,其中FFDM包括对SFM筛查女性进行计算机辅助检测(CAD)
s467 Sentence In the Edinburgh Trial, socioeconomic status, which correlates with the risk of breast cancer mortality, differed markedly between the intervention and control groups, so it is difficult, if not impossible, to interpret the results 社会经济状态被认为与乳腺癌死亡率相关,在Edinburgh试验中,社会经济状态在试验组和对照组间具有显著差别,因此,尽管不是不可能,对该试验的结果进行解析仍然是非常困难的
s468 Sentence Among women diagnosed with (and treated for) DCIS between 1984 and 1989, only 1.9% died of breast cancer within 10 years, which was a lower mortality rate than for the age-matched population at large 从1984年到1989年间,诊断(并接受治疗的)DCIS的女性中,仅有1.9%在10年内死于乳腺癌。相比于同年龄的普通人群而言,这一死亡率相对较低
s469 Sentence Four of the five Swedish trials were designed to include a single screening mammogram in the control group, timed to correspond with the end of the series of screening mammograms in the study group 在瑞典的5项临床试验中,4项试验的设计为:试验组接受一系列乳腺X线摄影筛查,并在最后一次筛查检查时,让对照组同时接受一次乳腺X线摄影的筛查检查
s470 Sentence A review of ten controlled studies of various designs found that, overall, digital mammography increases breast cancer detection (combining invasive cancer and DCIS) and that recall rates are not consistently better with either technology 对10项不同设计的对照研究进行总结,发现总体上数字乳腺X线摄影检查提高乳腺癌的检出率(包括侵袭性癌与DCIS),但两种检查方法的召回率并无一致结果
s471 Sentence These authors made the assumption that the annual decrease in mortality observed during the prescreening period would carry into the postscreening period, and any screening effect would result in an incremental decrease in mortality 因此,研究者们设想,筛查前死亡率呈现逐年递减的趋势,这种趋势会持续到筛查开展后;而筛查的效应会导致死亡率的降幅愈来愈大
s472 Sentence The same analysis for 10,000 women aged 40 to 49 years, assuming the same 500 abnormal examinations, results in an estimate that 488 of these will be false-positives, and 12 will be breast cancer 对10,000例年龄在40-49岁间的女性进行同样的估算分析,假设同样有500例异常结果,则其中488例为假阳性,而另外12例为乳腺癌
s473 Sentence More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages 关于总结政策和PDQ编辑委员会职能的更多信息请参见关于本PDQ总结和PDQNCI综合性癌症数据库页面
s474 Sentence The relative risks for death were 1.53 (95% CI, 1.17–2.00) for interval and incident cancers, compared with screen-detected cancers; and 1.36 (95% CI, 1.10–1.68) for cancers in the control group, compared with screen-detected cancers 与筛查检出肿瘤相比,间期和意外发现的肿瘤死亡相对风险为为1.53(95%CI,1.17-2.00);而对照组发现的肿瘤与筛查检出肿瘤相比,该数值为1.36(95%CI,1.10-1.68)
s475 Sentence A systematic review of ecologic and large cohort studies published through March 2011 compared breast cancer mortality in large populations of women aged 50 to 69 years who started breast cancer screening at different times 2011年3月发表的一篇系统综述总结了多项生态学及大型队列研究的结果。该综述选取了参与者为年龄在50到69岁间的女性群体研究,比较开始乳腺癌筛查的时间不同对乳腺癌相关死亡率的影响
s476 Sentence About 15% of women recalled will be recommended for biopsy, with 30% of cases assessed as BI-RADS 4, suspicious, yielding cancer; and 95% of cases assessed as BI-RADS 5, highly suggestive of malignancy, yielding cancer 约15%的女性被推荐进行活检明确诊断,BI-RADS 4类,即可疑恶性者中30%最终被确诊为乳腺癌,BI-RADS 5类,即高度提示恶性者中95%最终被确诊为乳腺癌
s477 Sentence All studies had methodological problems, including control group dissimilarities, insufficient adjustment for differences between areas in breast cancer risk and breast cancer treatment, and problems with similar measurement of breast cancer mortality between compared areas 所有的研究都存在方法学的不足,包括对照组的相异度、研究者对不同地区在乳腺癌风险及乳腺癌治疗方面的差异未予调整、以及对比地区用于计算乳腺癌相关死亡率的方法所存在的问题
s478 Sentence Whereas the breast neoplasm rate was only 2.6% for 352 women in whom no fluid could be aspirated, it was 5.5% for 327 women with epithelial hyperplasia and 10.3% for 58 women with atypical hyperplasia 然而在未抽吸出液体的352例女性中,乳腺肿瘤的发生率仅为2.6%, 327例表皮增生女性中,乳腺肿瘤发生率为5.5%,而58例不典型增生女性中,乳腺肿瘤发生率为10.3%
s479 Sentence A study of mammography screening in an Albuquerque health maintenance organization found that Hispanic women had consistently lower rates of screening than did whites (50.6% vs 65.5% in 1989, and 62.7% vs 71.6% in 1996) 一项针对乳腺钼靶筛查的阿尔伯克基健康保护组织研究发现,西班牙裔女性与白人相比,进行乳腺癌筛查的比例一直较低(1989年分别为50.6%和65.5%;1996年分别为62.7%和71.6%)
s480 Sentence There were 18 deaths from breast cancer in 100,738 life-years in the triennial screening group and 18 deaths from breast cancer in 88,780 life-years in the annual screening group (hazard ratio, 0.88; 95% CI, 0.59–1.27) 三年间隔组在100,738总人年数中有18例乳腺癌相关死亡病例;而1年间隔组在88,780总人年数中有18例乳腺癌相关死亡病例(风险比,0.88;95%CI, 0.59-1.27)
s481 Sentence Studies that provide information about this issue include nonrandomized controlled studies of screened versus nonscreened populations, case-control studies of screening in real communities, and modeling studies that examine the impact of screening on large populations 可能提供这一相关信息的临床研究包括以下类型:对比筛查与未行筛查人群的非随机对照试验、在真实社区内开展的病例对照研究、用于检验筛查对大型人群的影响的模型研究
s482 Sentence The only large, well-conducted, randomized clinical trial of BSE randomly assigned 266,064 women factory workers in Shanghai to receive either BSE instruction with reinforcement and encouragement, or instruction on the prevention of lower back pain 唯一一项针对BSE的组织妥善的大型随机临床试验将266,064例上海女工随机分为两组。试验组根据指导进行BSE,并在试验中不断的强化和鼓励,而对照组则根据指导预防下腰痛
s483 Sentence For example, one study reported that the recall rate is twice as high in the United States as it is in the United Kingdom, yet there is no difference in the rate of cancers detected 例如,一项研究发现美国的召回率是英国的2倍之多,而二者的肿瘤检出率并无差别
s484 Sentence Another study examined the usefulness of adding CBE to screening mammography; among 61,688 women older than 40 years and screened by mammography and CBE, sensitivity for mammography was 78%, and combined mammography-CBE sensitivity was 82% 另一项研究收录了61688名大于40岁的女性,观察在使用乳腺X线摄影进行筛查时,联合CBE是否可提高筛查效果
s485 Sentence Ecologic studies from the United States and the United Kingdom demonstrate an increase in DCIS and invasive breast cancer incidence since the 1970s, attributable to the widespread adoption of both postmenopausal hormone therapy and screening mammography 根据美国及英国的经济学研究结果,由于绝经后激素疗法和乳腺X线摄影筛查的广泛应用,自20世纪70年代起,DCIS和浸润性乳腺癌的发病率均有所上升
s486 Sentence A study of screening in women with a positive family history of breast cancer showed that, after a normal initial evaluation, the patient herself or her clinician performing a CBE identified more cancers than did mammography 一项筛查研究发现对于存在阳性乳腺癌家族史的女性而言,若患者在进行乳腺筛查前接受过正常的病史询问,那么随后进行的乳腺筛查中,使用CBE比使用乳腺X线摄影,会检出更多的乳腺癌
s487 Sentence A review of the literature and expert opinion by the European Group for Breast Cancer Screening concluded that “there is little evidence to support the use of ultrasound in population breast cancer screening at any age.” 欧洲乳腺癌筛查工作组发表了一篇总结既往文献和专家意见的综述,结论为“尚无明确证据支持使用超声波检查对任何年龄群体进行乳腺癌筛查”
s488 Sentence This difference in all-cause mortality was four times greater than the breast cancer mortality in the control group, and therefore, may account for the higher breast cancer mortality in the control group compared with screened women 全因死亡率的这种差异比对照组的乳腺癌相关死亡率高4倍,因而,这可能是对照组的乳腺癌死亡率高于筛查组的原因
s489 Sentence A well-conducted ecologic study compared three pairs of neighboring European countries, matched on similarity in health care systems and population structure, one of which had started a national screening program some years earlier than the others 一项执行得很好的生态学研究选取三对相邻的欧洲城市进行比较,其中每对城市在健康管理系统及人口结构方面相似,其中一个城市开启国家性筛查项目的时间较其它城市早几年
s490 Sentence About 10% of women screened will be recalled for additional evaluation; more than 80% of these will be considered normal or benign after a full diagnostic workup, which may include additional mammographic views, ultrasound, or both 接受筛查的女性中约有10%会被召回,并进行进一步检查和评估,完整的诊断流程至少要包括乳腺X线摄影和B超检查中至少一项。通过完整的诊断流程,最终被召回的女性中有80%被诊断为正常或良性病变
s491 Sentence An important issue in all of these studies is the extent to which they can control for additional effects on breast cancer mortality such as improved treatment and heightened awareness of breast cancer in the community 上述试验类型中都有一个重要的关键点,即都可以控制筛查通过促进治疗以及提高社区人群对乳腺癌的关注度等方式对乳腺癌相关死亡率产生的额外效应
s492 Sentence Other risk factors for breast cancer include an inherited predisposition ( BRCA1 or BRCA2 , and others); early age at menarche and late age at first birth; and previous breast biopsies showing benign proliferative breast disease 乳腺癌的其他高危因素还包括:遗传倾向(BRCA1 或 BRCA2及其他);初潮年龄早及首次生育年龄晚;既往乳腺活检提示良性增生性乳腺疾病
s493 Sentence Some of these women will die of breast cancer in spite of mammographic detection and optimal therapy, and some may live long enough to die of other causes even if the cancer had not been screen detected 尽管由乳腺X线摄影检出肿瘤并接受最佳治疗,这些女性中仍有部分会死于乳腺癌;而另有一部分患者即使没有被检出肿瘤,仍会继续生存,直至死于其他原因
s494 Sentence Although the number of invasive breast cancers diagnosed in the two groups was about the same, women in the instruction group had more breast biopsies and more benign lesions diagnosed than did women in the control group 尽管两组检出浸润性乳腺癌的病例数基本相等,但得到BSE指导的一组相比于对照组进行乳腺活检和检出良性病变的数目都更多
s495 Sentence Efforts to reduce bias in the attribution of mortality cause have been made, including the use of a blinded monitoring committee (New York) and a linkage to independent data sources, such as national mortality registries (Swedish trials) 研究者开发出多种手段减少死亡归因过程中的偏倚,包括启用设盲监督委员会(纽约试验)或使用独立数据来源,如国家死亡注册中心(瑞典试验)
s496 Sentence A 2009 combined analysis by six Cancer Intervention and Surveillance Modeling Network modeling groups found that screening every 2 years maintained an average of 81% of the benefit of annual screening with almost half the false-positive results 2009年对癌症干预和监测建模网络中六个建模组进行的联合分析显示,若每2年进行一次筛查,相比于每年一次筛查的方案,所带来的益处可以达到后者的81%,而假阳性事件的发生率却不足后者的一半
s497 Sentence There was great variation in results among the studies, with four studies finding a relative reduction in breast cancer mortality of 33% or more (with wide CIs) and five studies finding no reduction in breast cancer mortality 该综述提示不同研究的结果间存在巨大差异,其中四项研究中乳腺癌相关死亡率的相对下降率不小于33%(CI值范围较大),而另外五项研究中并无乳腺癌相关死亡率的下降
s498 Sentence The proportion of reduction in breast cancer mortality maintained in moving from annual to biennial screening for women aged 50 to 74 years ranged across the six models from 72% to 95%, with a median of 80% 综合六个建模组的数据可知,对于年龄在50到74岁间的女性,如果从每年筛查一次改为每两年筛查一次乳腺癌,后者带来的乳腺癌相关死亡率下降维持在前者的72%到95%不等,中位数80%
s499 Sentence One trial, the Canadian National Breast Screening Study (NBSS)-2, compared mammogram plus clinical breast examination (CBE) with CBE alone; the other eight trials compared screening mammogram with or without CBE to a control consisting of usual care 其中加拿大国家乳腺筛查研究(NBSS)-2比较了单独应用临床乳腺检查(CBE)筛查与CBE联合乳腺X线摄影筛查两种方式;而另外8项临床试验则将常规护理组作为对照,试验组则采取乳腺钼靶筛查,伴或不伴CBE
s500 Sentence Although the grade and node status were similar in both groups, more cancers of slightly smaller size were detected in the annual screening group, with a lead time of approximately 7 months in comparison with triennial screening 尽管两组在检出肿瘤级别、淋巴结状态等方面基本相似,但在一年间隔组检出的多数肿瘤体积较小,且检出时间较三年组领先约7个月
s501 Sentence Modeling makes assumptions that may not be correct; however, the credibility of modeling is greater when the model produces overall results that are consistent with randomized trials overall and when the model is used to interpolate or extrapolate 建模时所作的假设不一定正确;然而当模型的总体结论与随机临床试验的结果大体一致,以及模型被用于内推或外推时,模型的可信度较高
s502 Sentence In a retrospective study of 939 patients with 1,042 mammographically detected lesions who underwent core needle biopsy or surgical needle localization under x-ray guidance, sensitivity for malignancy was greater than 95% and the specificity was greater than 90% 一项回顾性研究收录了939例患者,这些患者通过乳腺X线摄影发现了1,042个病灶;对这些病灶分别进行粗针穿刺或在X-线导引下细针定位手术切除,该方法发现恶性病灶的敏感性大于95%,特异性高于90%
s503 Sentence One systematic review of observational studies of women exposed to large doses (≥20 Gy) of chest radiation before age 30 years found standardized incidence ratios of 13.3 to 55.5 for breast cancer, with no plateau with increasing age 一项系统性观察研究招募了在30岁前接受大剂量(≥20Gy)胸部放疗的女性,结果显示乳腺癌的标准化发病率在13.3-55.5之间,且未随着年龄增加而出现平台期
s504 Sentence The commonly quoted risk of one in eight women who will be diagnosed with breast cancer is based on lifetime risk of a diagnosis (not death) starting from birth and does not account for the woman’s current age 常常被引用的八分之一风险是指,每八位女性中就有一位会被诊断(而非死于)为乳腺癌;这一数据是从出生开始计算的终生诊断率,与女性的年龄阶段无关
s505 Sentence Cancers with longer preclinical durations are, by definition, present during more opportunities for discovery and therefore are more likely to be detected by screening; these cancers tend to be slow growing and to have better prognoses, irrespective of screening 较长的潜伏期意味着更多的机会发现肿瘤,也就是说此类肿瘤更有可能通过筛查检测出来;此类肿瘤大多生长缓慢、预后良好,而与筛查并不相关
s506 Sentence The positive predictive value (PPV) of an abnormal screening mammogram in this population was 6.3% for women aged 40 to 49 years, 6.6% for women aged 50 to 59 years, and 7.8% for women aged 60 to 69 years 对于40-49岁之间的女性,如乳腺钼靶检查的结果为异常,其阳性预测值(PPV)为6.3%;而对于50-59岁间的女性群体及60-69岁间的女性群体而言,该值分别为6.6%和7.8%
s507 Sentence The Canadian National Breast Screening Study (NBSS) compared high-quality CBE plus mammography to CBE alone in women aged 50 to 59 years (refer to the Clinical Breast Examination section in the Overview section of this summary for more information) 加拿大国家乳腺筛查研究(NBSS)录入了年龄在50到59岁间的女性,分为两组,一组使用高质量的CBE联合乳腺X线摄影进行筛查,而对比组则单独使用CBE进行筛查(更多信息参见本份总结概述部分临床乳腺检查一节)
s508 Sentence Higher interpretive accuracy of screening mammography was seen at facilities that offered screening examinations alone, included a breast imaging specialist on staff, did single as opposed to double readings, and reviewed interpretive audits two or more times each year 较高检查准确性常常见于仅进行筛查的机构,这类机构需要满足以下几点:有专门的乳腺影像科医师、 单人阅片而非双人阅片、每年至少2次专业稽查
s509 Sentence Women with radiologically dense breasts (heterogeneously dense or extremely dense in the terminology of the Breast Imaging Reporting and Data System [BI-RADS]) have a threefold to sixfold increased risk of breast cancer compared with women who have fatty breasts 相比于乳腺脂肪组织较多的女性而言,乳腺组织致密的女性(基于乳腺影像报告和数据系统[BI-RADS]分为不均匀致密或极其致密)发生乳腺癌的风险是前者的三到六倍
s510 Sentence The limitations are best described as false-positives (related to the specificity of the test), overdiagnosis (true-positives that will not become clinically significant), false-negatives (related to the sensitivity of the test), discomfort associated with the test, radiation risk and anxiety 其局限性包括:假阳性(与试验特异性相关)、过度诊断(指不具有临床意义的真阳性事件)、假阴性(与试验敏感性相关)、试验所致不适感、射线危害及焦虑
s511 Sentence Intervention: Invited group aged 48 years and younger offered annual screening by MMG (double-view first screen, then single mediolateral oblique view thereafter); 68% accepted screening on first screen and 69% to 70% were reinvited (81% attended at least one screen) 试验组:试验组对年龄在48岁及以下的受试者提供每年进行一次MMG筛查(第一次为双视图筛查,此后均为内外侧斜位视图);其中第一次筛查时有68%的受试者接受筛查,后向69%到70%的受试者再次发出筛查邀请(至少参加一次筛查的受试者占81%)
s512 Sentence The cumulative lifetime incidence decreases with advancing age because the longer a woman lives without a breast cancer diagnosis, the lower her lifetime risk compared to a younger woman who might develop breast cancer at a younger or older age 累积终生诊断率则随着年龄的增加而下降。这是因为,年轻的女性可能会在较小或较大的多个年龄阶段被诊断为乳腺癌,而年龄较大的女性在已经度过的年龄阶段已经不可能被诊断为乳腺癌,其终生诊断率相比于年轻女性自然较低
s513 Sentence This summary covers the topic of breast cancer screening and includes information about breast cancer incidence and mortality, risk factors for breast cancer, the process of breast cancer diagnosis, and the benefits and harms of various breast cancer screening modalities ​本总结涉及乳腺癌筛查相关主题,涵盖的信息包括:乳腺癌的发病率和死亡率、乳腺癌相关危险因素、乳腺癌诊断流程以及各种乳腺癌筛查手段的利弊
s514 Sentence In 2000, the National Cancer Institute formed a consortium of modeling groups (Cancer Intervention and Surveillance Modeling [CISNET]) to address the relative contribution of screening and adjuvant therapy to the observed decline in breast cancer mortality in the United States 在2000年,美国国家癌症研究所将多个建模组联合在一起(癌症干预和监测建模[CISNET]),用于评估筛查及辅助治疗手段分别对美国乳腺癌相关死亡率下降所作出的相对贡献
s515 Sentence The frequency of cancer diagnosis, stage, interval cancers, and breast cancer mortality were similar in the two groups and compared favorably with other trials of mammography alone, perhaps because of the careful training and supervision of the health professionals performing CBE 试验结果显示两组在以下方面均表现一致,即使是与其他单独应用乳腺X线摄影进行筛查的试验对比亦无差别。这些方面包括:检出肿瘤率、分期、间期癌及乳腺癌相关死亡率,导致上述结果的原因可能是实施CBE的专业人员接受过详细的培训和监管
s516 Sentence Some authors include DCIS with invasive breast cancer statistics, but others argue that the term be replaced by ductal intraepithelial neoplasia, similar to the terminology used for cervical and prostate precursor lesions, and that breast cancer statistics exclude these DCIS cases 一些研究者认为应将DCIS与浸润性乳腺癌放在一起进行数据统计;而其他研究者认为应类比宫颈及前列腺的癌前病变命名,将DCIS重新命名为导管上皮内瘤变,并在统计乳腺癌时除外这些DCIS病例
s517 Sentence A second DMIST report found that film mammography had a higher AUC in women aged 65 years and older (AUC 0.88 for film; AUC 0.70 for digital; P = .025); however, it was not statistically significant when the multiple comparisons were considered DMIST研究第二项分析结果显示,在年龄大于等于65岁的女性群体中,乳腺屏-片X线检查的肿瘤检出率更高(屏-片成像术的AUC为0.88;数字成像术的AUC为0.70;P=0.025);但上述结果在多重比较分析后,并未显示统计学显著差异
s518 Sentence It has been promoted as a screening test for breast cancer among women at elevated risk of breast cancer based on BRCA 1/2 mutation carriers, a strong family history of breast cancer, or several genetic syndromes such as Li-Fraumeni or Cowden disease 对于乳腺癌发生风险较高的人群推荐使用磁共振成像进行乳腺癌筛查,这些人群包括:BRCA1/2 突变携带者、明确乳腺癌家族史、及部分遗传综合征如Li-Fraumeni 综合征或Cowden氏病
s519 Sentence One might expect that if screening identifies cancers before they cause clinical symptoms, then the period of screening will be followed by a period of compensatory decline in cancer rates, either in annual population incidence rates or in incidence rates in older women 理论上,如果在肿瘤导致临床症状前通过筛查确立诊断,那么一段时间的筛查应用将会导致随后一段时间内肿瘤发生率的补偿性下降,如年人群发病率或老年女性的发病率
s520 Sentence The investigators estimated the operating characteristics for CBE alone; for 19,965 women aged 50 to 59 years, sensitivity was 83%, 71%, 57%, 83%, and 77% for years 1, 2, 3, 4, and 5 of the trial, respectively; specificity ranged between 88% and 96% 单独评估CBE的各项指标,结果显示对于19,965例年龄在50-59岁之间的女性而言,在检查第1、2、3、4及5年的敏感性分别为83%、71%、57%、83%及77%;而特异性则在88%到96%之间
s521 Sentence Randomization: Complex; cluster randomly assigned within birth year by day of birth for older group (aged 50–59 years) and by individual for younger group (aged 39–49 years); ratio of study to control varied by year depending on MMG availability (randomization took place 1982–1984) 随机分组:复杂:对于老年人群(年龄在50到59岁之间),根据出生年份按日期进行分组;而对于较年轻人群(年龄在39到49岁之间),进行个体随机分组;由于MMG可用性的不同(1982年到1984年间随机安排),试验组与对照组的人数比值各年也不同
s522 Sentence False-positive rates are also higher at facilities serving vulnerable women (women of racial or ethnic minorities and women with lower educational attainment, limited household income, or rural residence) than at facilities serving nonvulnerable women, perhaps because of poorer compliance with recommendations for follow-up examinations 此外,为弱势群体的女性(少数民族或种族的女性、或低教育程度、低收入及乡村妇女)提供服务的机构相比于为非弱势群体的女性服务的机构,其假阳性率也会较高;这可能是因为该群体的女性患者对于进行进一步检查的依从性更差
s523 Sentence A telephone survey of 308 women performed 3 months after screening mammography revealed that about one-fourth of the 68 women with a “suspicious” result were still experiencing worry that affected their mood or functioning, even though subsequent testing had ruled out a cancer diagnosis 一项电话调研一共调查了308例女性,这些受试者均在调查前3个月接受过乳腺钼靶筛查,结果显示68例女性的检查结果为“可疑”,而这些女性中四分之一的受试者直至接受调查时仍然存在担忧。这种情绪严重影响了患者的情绪和社会活动,即使后续的检查结果已经排除了乳腺癌的诊断
s524 Sentence The Million Women Study in the United Kingdom revealed three patient characteristics that were associated with decreased sensitivity and specificity of screening mammograms in women aged 50 to 64 years: use of postmenopausal hormone therapy, prior breast surgery, and body mass index below 25 英国百万妇女研究发表的结果显示,对于50-64岁间的女性患者,以下三种患者特征与乳腺X线摄影筛查的敏感性及特异性降低相关,包括:绝经后激素替代治疗、既往乳腺手术史及体重指数小于25
s525 Sentence The Canadian National Breast Screening Study-2 of women aged 50 to 59 years found a fourfold increase in DCIS cases in women screened by clinical breast examination (CBE) plus mammography compared with those screened by CBE alone, with no difference in breast cancer mortality 加拿大国家乳腺癌筛查研究-2招募了年龄在50至59岁的女性,分为2组,第一组采用临床乳腺检查(CBE)及乳腺X线摄影联合筛查乳腺癌;而第二组则单独采用CBE进行筛查,统计结果显示第一组发现的DCIS病例是第二组的4倍之多;而两组的乳腺癌死亡率并无差别
s526 Sentence The most important bias in this study is that the advent of screening in these counties occurred over a period during which dramatic improvements in the effectiveness of adjuvant breast cancer therapy were being made, changes which were not addressed by the study authors 该项研究中最重要的偏倚是,筛查项目在这些城市被推广应用的时间刚好处于乳腺癌辅助治疗手段突飞猛进的时期,而这些改变恰恰被试验的研究者忽略了
s527 Sentence Lead-time bias: Survival time for a cancer found mammographically includes the time between detection and the time when the cancer would have been detected because of clinical symptoms, but this time is not included in the survival time of cancers found because of symptoms 领先时间偏倚:乳腺X线摄影发现的乳腺癌患者,其生存时间包含了检查发现乳腺癌到(如果不做检查)因出现临床症状而检出癌症的时间,但对于因症状发现的癌症患者而言,其生存时间不包括这段时间
s528 Sentence Whereas reproductive factors such as age at first full-term birth, parity, and duration of lactation accounted for some of the ethnic differences in breast cancer incidence for postmenopausal women, there was no evidence that these factors played a role in the differences for premenopausal patients 对绝经后女性而言,其乳腺癌发病率在不同种族中的不同与多种生育因素有关,如初次足月分娩的年龄、产次、哺乳时间长短有关;然而对绝经前女性而言,尚无证据证明上述因素与乳腺癌发病率的差异有关
s529 Sentence The sensitivity of mammography (refer to the Breast Cancer Screening Concepts section of this summary for more information) ranges from 70% to 90%, depending on a woman’s age and the density of her breasts, which is affected by her genetic predisposition, hormone status, and diet 乳腺X线摄影的敏感性(更多信息参见本总结乳腺癌的筛查概念一节)在70%到90%之间,与女性的年龄及其腺体密度有感;后者则受多种因素影响,包括女性的遗传易感性、激素状态及饮食习惯
s530 Sentence Because only a part of the overall reduction in breast cancer mortality could possibly be attributed to screening, the review concluded that any relative reduction in breast cancer mortality due to screening would likely be no more than 10%, less than predicted by the RCTs 事实上研究结果中乳腺癌相关死亡率的下降,只有一部分源于乳腺癌筛查技术的开展;而综述认为这一部分不超过10%,且远远低于随机对照试验所预测的结果
s531 Sentence However, no compensatory drop in incidence rates has ever been seen following the adoption of screening, suggesting that screening leads to overdiagnosis—the identification of clinically insignificant cancers (refer to the Overdiagnosis section in the Harms of Screening Mammography section of this summary for more information) 然而事实上,广泛的筛查并未引起发病率的代偿性下降,提示筛查可能导致了过度诊断,即对临床上不重要的肿瘤作出诊断(更多信息参见本份总结 乳腺X线摄影筛查的危害 部分中过度诊断部分)
s532 Sentence Similarly, an examination of the breast cancers found in three randomized screening trials (Health Insurance Plan, National Breast Screening Study [NBSS]-1, and NBSS-2) accounted for stage, nodal status, and tumor size and determined that patients whose cancer was found via screening have a more favorable prognosis 同样,另外三项筛查相关随机临床试验(健康保险计划、国家乳腺筛查研究[NBSS]-1和NBSS-2)同样对乳腺癌特性进行分析,包括分期、肿瘤大小、淋巴结情况等,结果显示筛查检出肿瘤具有更好的预后
s533 Sentence Third, and last, a case-control study nested within the Canadian NBSS compared self-reported BSE frequency before enrollment with breast cancer mortality. Women who examined their breasts visually, used their finger pads for palpation, and used their three middle fingers had a lower breast cancer mortality rates 第三项研究,也是最后一项研究,来自加拿大NBSS的病例对照研究,该研究对比了乳腺癌相关死亡率的病例及其入组前自检BSE的频率。结果显示使用以下方法进行乳腺自检的女性受试者,其乳腺癌相关死亡率更低,这些方法包括:肉眼检查、使用指腹触诊及使用中间三指进行检查
s534 Sentence One such effort analyzed a series of 706 DCIS patients who were monitored to develop the University of Southern California/Van Nuys Prognostic Scoring Index, which defines the risk of recurrent DCIS and invasive cancer among women with DCIS based on age, margin width, tumor size, and grade 一项研究对706例DCIS患者进行了追踪,并根据这些结果开发了南加州大学/凡奈预后评估指数,即在罹患DCIS的患者中,根据年龄、切缘宽度、肿瘤大小及级别等计算出DCIS复发及进展为浸润癌的风险值
s535 Sentence The relative risk (RR) of detecting localized breast cancer was 3.3 (95% CI, 3.1–3.5) among screened women. Diagnosis of metastatic cancer was reduced among screened women (RR = 0.57), suggesting a benefit of mammography screening in elderly women, though it comes with an increased risk of overdiagnosis 研究显示,在筛查女性中,检出局限性乳腺癌的相对危险度(RR)为3.3(95%CI,3.1-3.5),而转移性癌症的诊断率下降(RR,0.57);这意味着筛查性乳腺X线摄影对于老年女性确有受益,尽管这种受益是建立在过度诊断风险提高的基础上
s536 Sentence The 5-year relative survival rate for localized disease was 99.3% for white women and 92.6% for black women; for regional disease, it was 85.2% for white women and 72% for black women; and for distant disease, it was 24.7% for white women and 14.8% for black women 局灶性肿瘤的5年相对生存率在白人女性和黑人女性中分别为99.3%和92.6%;而对于区域性肿瘤,上述数值在白人和黑人女性中则分别为85.2%和72%;远处转移肿瘤的5年相对生存率在白人女性和黑人女性中分别为24.7%和14.8%
s537 Sentence Because all studies of MRI screening are observational, none can assess morbidity, survival, or mortality, compared with other screening modalities, though it is likely that MRI screening results in overdiagnosis (refer to the Overdiagnosis section in the Harms of Screening Mammography section of this summary for more information) 尽管表面上看MRI筛查更容易导致过度诊断(更多信息参见本份总结筛查性乳腺X线摄影的危害部分的过度诊断一节),但由于MRI相关所有研究均为观察性研究,因此无法对比MRI与其他筛查方法在乳腺癌相关发病率、生存率及死亡率方面的差异
s538 Sentence After adjusting for changes in incidence due to hormone therapy and other undefined causes, the authors concluded that the screening effect on breast cancer mortality reduction (28% during this period) was small, and that overdiagnosis of breast cancer was likely between 22% and 31% of all diagnosed breast cancers 在调整了激素治疗及其他不确定因素对发病率的影响后,研究结果显示筛查本身导致乳腺癌相关死亡率下降的程度(试验期间为28%)很小,而在所有被诊断乳腺癌的病例中,过度诊断的比例约在22%到31%之间
s539 Sentence In a large U.S. cohort study that was included in the meta-analysis, sensitivity for women younger than 50 years was 75.7% (95% CI, 71.7–79.3) for film mammography and 82.4% (95% CI, 76.3–87.5) for digital mammography; specificity was 89.7% (95% CI, 89.6–89.8) for film and 88.0% (95% CI, 88.2–87.8) for digital 该荟萃分析中纳入的一项大型美国队列研究发现对于年龄小于50岁的女性而言,乳腺屏-片和数字乳腺X线摄影的敏感性分别为75.7%(95%CI,71.7-79.3)和82.4%(95%CI,76.3-87.5);特异性分别为89.7%(95%CI,89.6-89.8)和88.0%(95%CI,87.8-88.2)
s540 Sentence Breast magnetic resonance imaging (MRI) may be used in women for diagnostic evaluation, including evaluating the integrity of silicone breast implants, assessing palpable masses following surgery or radiation therapy, detecting mammographically and sonographically occult breast cancer in patients with axillary nodal metastasis, and preoperative planning for some patients with known breast cancer 乳腺磁共振成像(MRI)可被用于女性乳腺疾病的诊断评估,包括评估硅胶乳房假体的完整性、评估手术或放疗后的可触性包块、在已有腋窝淋巴结转移的患者中发现乳腺X线摄影及超声检查未能检出的隐匿性乳腺癌、以及为一些已知乳腺癌患者进行术前规划
s541 Sentence An audit of mammograms performed in 1998 at a single institution revealed that 14.7% of examinations resulted in a recommendation for additional testing (Breast Imaging Reporting and Data System category 0), 1.8% resulted in a recommendation for biopsy (categories 4 and 5), and 5.7% resulted in a recommendation for short-term interval mammography (category 3) 1998年一所研究所进行的乳腺钼靶检查稽查发现被检查者中有14.7%被推荐进行进一步的检查(乳腺影像报告和数据系统分类:0),而1.8%的受试者被推荐进行活检(分类4和5),另有5.7%的受试者被推荐在短期内重复进行乳腺钼靶检查(分类3)
s542 Sentence The association among women at increased risk due to a family history of breast cancer or a previous breast biopsy (OR = 0.74; 95% confidence interval [CI], 0.50–1.03) was stronger than that among women at average risk (OR = 0.96; 95% CI, 0.80–1.14), but the difference was not statistically significant ( P = .17) 此外,研究结果显示,对于乳腺癌高危女性,即具有既往乳腺活检病史或乳腺癌家族史的女性,上述联系(OR,0.74;95%置信区间[CI],0.50-1.03)要强于平均危险程度的女性(OR,0.96;95%CI,0.80-1.14),但这种差别不具有统计学显著差异(P=0.17)
s543 Sentence A large observational study found a slightly increased risk of late-stage disease at diagnosis for women in their 40s who were adhering to a 2-year versus a 1-year schedule (28% vs 21%; odds ratio (OR) = 1.35; 95% confidence interval [CI], 1.01–1.81), but no difference was seen for women in their 50s or 60s 一项大型观察性研究发现,对于40岁的女性,如果每2年进行一次乳腺癌筛查,和每年一次筛查相比,在检出乳腺癌时肿瘤为晚期的风险轻度升高(分别为28%与21%;比值比(OR),1.35;95%置信区间[CI],1.01-1.81);在50岁或60岁的女性中进行类似对比,两组没有差别
s544 Sentence Although the RCTs of screening have addressed the issue of screening efficacy (i.e., the extent to which screening reduces breast cancer mortality under the ideal conditions of an RCT), they do not provide information about the effectiveness of screening (i.e., the extent to which screening is reducing breast cancer mortality in the U.S. population) 尽管对筛查的RCT研究能够描述筛查的效力(即在RCT的标准设置下,筛查降低乳腺癌相关死亡率的程度),但它们无法给出关于筛查有效性的信息(即在美国人群中,筛查引起乳腺癌相关死亡率下降的程度)
s545 Sentence Another study that compared the characteristics of 279 screen-detected cancers with those of 150 interval cancers found that interval cancers were much more likely to occur in women younger than 50 years and to be of mucinous or lobular histology; or to have high histologic grade, high proliferative activity, relatively benign features mammographically and/or to lack calcifications 另一项研究对比了279例筛查诊断的乳腺癌与150例间期癌的特性,结果提示间期癌更多见于年龄小于50岁的女性人群,且多为粘液性或小叶性。此外,间期癌往往具有更高的组织学级别、更强的增生能力、相对良性的乳腺X-线表现、伴或不伴钙化
s546 Sentence A meta-analysis of RCTs conducted for the U.S. Preventive Services Task Force in 2009 (including the AGE Trial) found that the number needed to invite to screen for 10 years to avoid or delay one death from breast cancer was 1,904 for women in their 40s, 1,339 for women in their 50s, and 377 for women in their 60s 对2009年美国预防服务工作组的RCT(包括AGE临床试验)进行荟萃分析,结果显示对于40-49岁的女性,为了避免或推迟1例乳腺癌相关死亡病例,需要在10年内对1,904名女性进行筛查;而对于年龄在50-59岁间的女性及60-69岁间的女性而言,这一数字分别为1,399名和377名女性
s547 Sentence Overdiagnosis and Resulting Treatment of Insignificant Cancers : Diagnosis of cancers that would otherwise never have caused symptoms or death in a woman’s lifetime can expose a woman to the immediate risks of therapy (surgical deformity or toxicities from radiation therapy, hormone therapy, or chemotherapy), late sequelae (lymphedema), and late effects of therapeutic radiation (new cancers, scarring, or cardiac toxicity) 微小癌的过度诊断及过度治疗:微小癌指患者在有生之年永远不会因为该肿瘤产生症状或导致死亡;而对微小癌做出诊断反而会使患者暴露于多种危险之下,包括治疗的即刻损伤(手术致残及放疗、激素疗法、化疗的毒性)、晚期并发症(淋巴水肿)及治疗性辐射的晚期反应(新发肿瘤、瘢痕形成或心脏毒性)
s548 Sentence Cumulative risk of at least one false-positive by the ninth mammogram varied from 5% to 100%, depending on four patient variables (younger age, higher number of previous breast biopsies, family history of breast cancer, and current estrogen use) and three radiologic variables (longer time between screenings, failure to compare the current and previous mammograms, and the individual radiologist’s tendency to interpret mammograms as abnormal) 根据各种变量的不同设定,在第九次乳腺钼靶检查检查时,至少出现一次假阳性事件的累积风险波动于5%到100%之间,与四个患者变量(年龄小、既往乳腺活检次数较多、乳腺癌家族史及正在应用雌激素)和三个放射学变量(筛查间隔较长、无法与前次乳腺X-线成像结果对比、及影像科医师倾向于做出异常结果诊断)相关
s549 Sentence A subsequent analysis and modeling of data from the same cohort of women, all of whom were continuously enrolled in the Harvard Pilgrim Health Care plan from July 1983 through June 1995, estimated that the risk of having at least one false-positive mammogram was 7.4% (95% confidence interval [CI], 6.4%–8.5%) at the first mammogram, 26.0% (95% CI, 24.0%–28.2%) by the fifth mammogram, and 43.1% (95% CI, 36.6%–53.6%) by the ninth mammogram 哈佛朝圣者医疗保健计划从1983年七月至1995年六月持续从上述研究的女性队列中纳入参与者,进行后续分析和数据建模。其结果显示该群体进行第一次乳腺钼靶检查检查时,出现至少一次假阳性结果的风险约为7.4%(95%置信区间[CI]为6.4%-8.5%);而第五次及第九次检查时该概率分别为26.0%(95%CI,24.0%-28.2%)和43.1%(95%CI,36.6%-53.6%)