12月份的Breast Cancer Research and Treatment雜志上刊登一項(xiàng)新研究"Impact of mammographic screening on the detection of good and poor prognosis breast cancers"表明,，在如今乳腺X線攝影篩查普及的時(shí)代，49~60歲女性中“低風(fēng)險(xiǎn)”和“超低風(fēng)險(xiǎn)”乳腺癌顯著增加,。作者提到,，篩查如今似乎更優(yōu)先確定人群中低風(fēng)險(xiǎn)的病變。該研究為低風(fēng)險(xiǎn)病變檢測(cè)增加提供了第一個(gè)分子證據(jù),。
該研究使用來(lái)自荷蘭的數(shù)據(jù),，比較了1984~1992年診斷確認(rèn)的乳腺癌（乳腺X線攝影不是常規(guī)檢測(cè)）婦女隊(duì)列和2004~2006診斷確認(rèn)的乳腺癌婦女隊(duì)列（乳腺X線攝影篩查時(shí)代）。
對(duì)兩個(gè)隊(duì)列中49~60歲的婦女進(jìn)行比較,，前一個(gè)隊(duì)列中低風(fēng)險(xiǎn)乳腺癌的比例較?。?0.6%; 67 of 165），后一個(gè)隊(duì)列較大（58%; 119 of 205）,。
這項(xiàng)研究?jī)H限于淋巴結(jié)陰性乳腺癌患者,，使用荷蘭癌癥研究所的70-基因乳腺癌預(yù)后檢測(cè)評(píng)估風(fēng)險(xiǎn)，該項(xiàng)測(cè)試，商業(yè)上稱為MammaPrint,，可以預(yù)測(cè)總體生存和遠(yuǎn)處轉(zhuǎn)移的進(jìn)展,，也可確認(rèn)超低風(fēng)險(xiǎn)的疾病。
調(diào)查者報(bào)告了2個(gè)隊(duì)列中超低風(fēng)險(xiǎn)婦女的亞組人群,，再次發(fā)現(xiàn),，隨著時(shí)間推移，這類人群的人數(shù)增加,。在第一個(gè)隊(duì)列中,，10%的49~60歲女性是超低風(fēng)險(xiǎn)乳腺癌，第二個(gè)隊(duì)列中位30%,。值得注意的是,，在小于40歲的女性中，兩個(gè)隊(duì)列之間低風(fēng)險(xiǎn)疾病的比例沒(méi)有顯著差異,。
這些結(jié)果意味著什么,？作者認(rèn)為應(yīng)該促使乳腺癌篩查和診療策略的改變。他們建議,，因?yàn)榈颓致孕缘娜橄侔┰黾?，?yīng)該有相應(yīng)的針對(duì)低侵略性乳腺癌的治療方法出現(xiàn)，甚至在某些情況下,，有相應(yīng)的診斷方法的出現(xiàn),。
該研究認(rèn)為我們應(yīng)該改善篩查，在篩查時(shí)應(yīng)該引進(jìn)分子檢測(cè)例如MammaPrint和Oncotype DX,，幫助確認(rèn)低風(fēng)險(xiǎn)腫瘤,，目前，這些檢測(cè)用于診斷后指導(dǎo)治療,。
但是有一個(gè)專家不贊同在篩查時(shí)使用這些檢測(cè),，將分子檢測(cè)添加到篩查聽(tīng)起來(lái)很吸引人，Kandace McGuire說(shuō)到,，但是分子檢測(cè)需要活組織切片,，在篩查級(jí)別進(jìn)行是不合適的。使用70-基因篩查技術(shù),，可以用于指導(dǎo)治療而不是診斷,。
盡管如此，該文的作者認(rèn)為,，將70-基因檢測(cè)技術(shù)整合進(jìn)入篩查的主要目的是為了避免過(guò)度治療,。（生物谷Bioon.com）
doi:10.1007/s10549-011-1748-z
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Impact of mammographic screening on the detection of good and poor prognosis breast cancers.
Esserman LJ, Shieh Y, Rutgers EJ, Knauer M, Retèl VP, Mook S, Glas AM, Moore DH, Linn S, van Leeuwen FE, van 't Veer LJ.
We sought to compare the molecular signature of node negative cancers from two cohorts 15 years apart, to determine if there is molecular evidence of increase in low and ultralow risk cancers over time. We studied the impact of age, time period of diagnosis, and mammographic screening on biology of tumors where The Netherlands Cancer Institute 70-gene prognosis signature was generated as part of 2 validation series, one retrospective (1984-1992), Cohort 1, and one prospective (2004-2006), Cohort 2. A total of 866 patients were analyzed. Regardless of time period of diagnosis, the proportion of T1, grade 1, hormone receptor positive (HR) tumors, and good prognosis by 70-gene signature significantly increases as age increases (P < 0.01). In women aged 49-60, the time period of diagnosis significantly affects the proportion of cancers that were NKI 70-gene low risk: 40.6% (67/165) compared with 58% (119/205) for Cohorts 1 and 2, respectively. This is in contrast to the absence of a significant change for women under age 40, where 25% (17/68) and 30% (17/56) were low risk in Cohorts 1 and 2, respectively. In women aged 49-60, using an ultralow risk threshold of the 70-gene signature, 10% of tumors in Cohort 1 were ultralow risk compared with 30% for women with screen-detected cancers in Cohort 2. Older age and method of detection (screening) are associated with a higher likelihood of a biologically low risk tumor. In women over age 50, biologically low risk tumors are frequent and tools that classify risk may minimize overtreatment.
