乳腺癌二级预防--上海266064名妇女乳房自我检查效果的评估  

Secondary Prevention for Breast Cancer:Evaluation on Effect of Breast Self-examination in 266 064 Women in Shanghai

作　　者：高道利[1] 王文婉[1] 胡永伟[2] 陈范良 潘雷达 袁亚 郁领娣 钱锋[1] 姚引珍 杨如法 

机构地区：[1]复旦大学附属中山医院分部,上海200052 [2]上海市东医院,上海200438 [3]上海纺织局卫生科,上海200336 [4]上海普陀区人民医院,上海200060

出　　处：《中国肿瘤》2008年第4期264-269,共6页China Cancer

基　　金：美国国立癌症研究所(NCI)与R1CA46823-14

摘　　要：[目的]论证及评估乳房自我检查(BSE)作为乳腺癌二级预防的作用及推广价值。[方法]大样本前瞻性随机对照研究。自1989年10月起,上海纺织系统519个单位266064名年龄在30￣64岁妇女,按单位整体随机进入指导组(BSE组,132979人)或对照组(133085人)。BSE组对入组妇女进行强化型BSE教育和指导5年,持续密切观察两组人群乳房疾病的发生、手术和生存状况7年。对乳腺癌患者随访到2001年12月,实际随访12年。统计分析采用Kaplan-Meier方法、Log-Rank检验以及Cox模型。[结果]BSE组检出乳腺癌864例,死亡133例;对照组检出乳腺癌896例,死亡130例。两组检出率分别为70.6/10万、72.6/10万(P>0.05),两组累积死亡率分别为150.6/10万、120.6/10万(P=0.72)。肿块直径≤2.0cm,两组检出率分别为48.0%、44.6%(P=0.07);0+Ⅰ期病例分别为29.7%、27.6%(P=0.39),两组差异均无统计学意义。良性肿块检出率分别为2.3%、1.2%,特别是纤维腺瘤检出率及肿块大小,两组差异有显著性(P<0.01)。[结论]对女性人群开展BSE教育和指导不能提高乳腺癌的早期诊断率和降低死亡率;在指导组存在过度诊断,造成过多的乳房良性病变被手术切除。[Purpose ] To evaluate the effect of breast self-examination （BSE） as secondary prevention and its popularization value. [Methods] A randomized controlled trial （RCT） including 266 064 women （age of 30 to 64 years） in 519 textile factories in Shanghai was randomly assigned to a BSE group （132 979 women） or a control group （133 085 women） since Oct.1989. Women in BSE group were followed by reinforcement instruction and guidance for 5 years. These activities were continued for 5 years. Attendance at all events about occurrence of breast cancer, operation and survival status was recorded for 7 years. The breast cancer cases were followed up to Dec. 2001 （12 years）. The data analysis methods included Kaplan-Meier plots, Log-Rank test and Cox modeling. [Results ] In BSE group, 864 cases with breast cancer （70.6/10^5） were detected and 133 cases died; and in the control group 896 cases with breast cancer （72.6/10^5） were detected and 130 cases deaths recorded group （P〉0.05）. The cumulative breast cancer mortality rates were 150.6/10^5 in BSE group and 120.6/10^5 in control group （P=0.72）. The detection rate of tumor size （φ≤2.0cm） were 48.0% in BSE group and 44.6% in control group （P=0.07）; TNM stage （0＋Ⅰ）, 29.7% in BSE group and 27.6% in control group （P=0.39）. The detection rates of benign mass were 2.3% in BSE group and 1.2% in control group （P〈0.01）. However, there was significant difference on the detection rate of benign mass especially fibroadenomas and tumor size between two groups. [Conclusion] Intensive instruction in BSE for female population can not improve early detection rate and reduce mortality rate for breast cancer. There is over-diagnosis, and more benign breast lumps being excised in BSE group.

关 键 词：乳房自我检查 随机对照试验 乳腺肿瘤 过度诊断 二级预防 

分 类 号：R737.9[医药卫生—肿瘤]