��

��. ��:

21-Jul-2000

�� , 16(6), ��-�� 1999, 574-579

��

�. ��, �. ��
�� , �� , �� , ��

�� : �� , �� , �� , ��

�� 1971, �� Shapiro et al �� 40�69 �� 1963� 1969.¹

�� , �� . ^2�5

�� , �� , �� .⁶ � �� (sojour time), �� , �� .⁷

�� 162.981 �� 40�74 �� 30%, �� 21% �� 40�65 ��.^8,9

�� 1989, � �� :

� � �� 35�40 ��.

� � ��, �� , �� 1�2 �� 40�49 ��.

� �� 50 �� .¹⁰

�� 3,5 �� , �� 1993, �� 40�49 ��.

�� , ��, � �� 50 �� .¹¹

��, �� 40�49 ��.¹⁰

�� 1994, � �� 40�74 ��.¹²

�� , �� 22%.¹²

�� , �� 1997, �� 40�49 �� , �� 24%.¹³

��
�� 40�49 �� ;

�� 40�49 �� 1,3�1,6 �� 1.000 �� , �� 2,2�2,6 �� 50�59 �� 3,3�3,9 �� 60�69 ��.¹⁰

�� Sur veillance Epidemiology and End Results (SEEP), ��, �� 40�49 �� 1993, ��, �� 28.900 �� 40�49 ��.¹⁰� �� 8% �� 50�59 ��, �� 31.500.¹⁴

�� 40�49 �� 16% �� . �� 17% �� 50�59 ��. �� 40�49 ��, �� , �� .¹⁵

�� 50 ��, �� , �� .^16,17 �� , � �� , �� 40�49 �� 50�59 ��.

�� , �� 50 ��.¹⁵

� �� Prechtel et al, �� 50 ��.¹⁸

�� GCSF �� 40�49 �� , � �� 90%, �� 88% �� .¹⁹

�� 40% �� 50 ��.²⁰

� �� , �� 40�49 ��, �� , �� , �� , �� 40�49 �� 50 ��, �� .¹⁰ ��, �� 40 ��.^21�23

�� ;

�� . ��, �� .^21�23 �� , �� .

�� : (�) �� (�) �� .

�� Pelikan et al �� 260 ��,²⁴ �� Tabar et al �� (sojour time) �� 1,25 �� 40 �� 3,03 �� 50 ��.²⁵

�� 40�49 �� , �� 50 ��.²⁶ ��, �� , �� ,�� 50 ��.

�� 40�49 �� , �� , �� 40�49 �� 50 �� .^10,19

�� 40�49 �� , � �� .

�� ;

� �� . �� 50% �� 60% �� 65 ��.²⁷ � �� .^28,29

�� 50�69 ��, �� 65�74 ��.³⁰

�� , ��, �� 74 ��.

�� .³¹ ��, �� 75 �� .^32,33

�� ;

�� , � �� , �� 0,25�20 Gy (25�2.000 rads).^34,35

�� , �� . � �� 10 �� .

� �� 4 mGy. �� , �� 100.000 �� , �� 40 ��, �� 8 �� .³⁶

� ��

�� , �� , �� .

�� , �� , �� .³⁷ �� 30 �� , � �� .

�� , � �� . �� , � �� (�� ) �� .

�� 30 �� , �� .

�� , �� , � �� , �� , �� .

� ��

�� .

� �� ³⁸ (��. 1).

�� . ��, �� .

�� , �� , �� .

��, � �� in situ �� in situ �� .

��, �� . �� , �� .

��

�� , �� 40�49 �� 50�59 ��. ��, �� 40�49 ��, �� 40 ��.
�� . ��, �� , �� 75 ��.
� �� >40 �� (� ��), �� .
� �� <30 �� , �� 30 �� .
� �� , �� .

��

SHAPIRO S, STRAX P, VENET L. Periodic breast cancer screening in reducing mortality from breast cancer. JAMA 1971, 215:1777� 1785
SHAPIRO S, STRAX P. Evidence of screening for breast cancer from a randomized trial. Cancer 1987, 39(Suppl 6):2772�2782
TABAR L, GAD A, HOLMBERG LH ET AL. Reduction in mortality from breast cancer after mass screening with mammography: Randomized trial from the Breast Cancer Screening Workshop Group of Swedish National Board of Health and Welfare. Lancet 1985, i:829�832
VERBEEK ALM, HOLLAND R, STURMANS F, HENDRICKS JHCL, MRAVUNAC M, DAY NE. Reduction of breast cancer mortality through mass screening with modern mammography: first results of a Nijmegen Project 1975�1981. Lancet 1984, i:1222�1224
TABAR L, FAGERBERG G, DUFFY S, DAY N. The Swedish two country trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Commun Health 1989, 43:107�114
HARRIS JR, HELLMAN S. Natural history of breast cancer. In: Harris JR, Lippman ME, Morrow M, Hellman S (eds) Diseases of the Breast. Philadelphia, Lippincott-Raven, 1996
HALSTED WS. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1989 to January 1984. Johns Hopkins Hosp Bull 1894�1895, 4: 297
TABAR L, FAGERBERG G, CHEN HH ET AL. Efficacy of breast cancer screening by age: new results from the Swedish two-country trial. Cancer 1995, 75:2507�2517
LIDBRINK E. Mammographic screening for breast cancer: aspects on benefits and risks. Dissertation. Karolinska Institute, Stockholm, Sweden, 1995
KOPANS DB. Mammography screening and the controversy concerning women aged 40�49. Radiol Clin North Am 1995, 33: 1273�1290
KERLIKOWSKE K, GRADY D, RUDING SM ET AL. Efficacy of screening mammography. A meta-analysis. JAMA 1995, 273:149�154
WALD N, CHAMBERLAIN J, HACKSHAW A. European Society of Mastology; Consensus Conference on Breast Cancer Screening, Paris, 1993. The effect of screening on breast cancer mortality. Oncology 1994, 51:380�389
HENDRICK RE, SMITH RA, RUTLEDGE JH III ET AL. Benefit of screening mammography in women aged 40�49. A meta-analysis of new randomized controlled trial results. American Cancer Society Workshop on Guidelines for Breast Cancer Detection, Chicago, 1997
SMITH RA. Epidemiology of breast cancer. In: A categorical course in physics: Technical aspects of breast imaging. 2nd ed. Oak Brook, Illinois, RSNA Publ, 1993:21�33
KOPANS DB. Conventional wisdom: observation, experience, anecdote, and science in breast imaging. Am J Roentgenol 1994, 162: 299�303
BASSETT LW, HENDRICK RE, BASSFORD TL ET AL. Quality determinants of mammography: clinical practice guideline No 13. AHCPR Publ No 95�0632, Rockville DHHS, PHS, AHCPR, 1994
FEIG SA. Determination of mammographic screening intervals with surrogate measures for women aged 40�49 years (editorial). Radiology 1994, 193:311�314
PRECHTEL K. Mastopathic and Altersabhangige Brystdrusen Verandernagen. Fortscher Med 1971, 89:1312�1315
KERLIKOWSKE K, GRADY D, BARKLAY J ET AL. Effect of age breast density and family history on the sensitivity of first screening mammography. JAMA 1996, 276:33�38
SHAPIRO S, VENET W, STRAX P ET AL. Periodic screening for breast cancer. The Health Insurance Plan Project and its Sequelae. 1963�1986. Baltimore, The Johns Hopkins University Press, 1988
SMART CR, HENDRICK RE, RUTLEDGE III JH ET AL. Benefit of mammography screening in women aged 40�49 years. Current evidence from randomized controlled trials (published erratum appears in Cancer 1995, 75:2788). Cancer 1995, 75:1619�1626
NYSTROM L, RUTQVIST LE, WALL S ET AL. Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet 1993, 341:973�978
SMART CR. Highlights of the evidence of benefit for women aged 40�49 years from the 14 year follow-up of the breast cancer detection demonstration project. Cancer 1994, 74:296�300
PELIKAN S, MOSKOWITZ M. Sum and substance. Cancer 1993, 71: 1998�2005
TABAR L, FAGERBERG G, DUFFY DW ET AL. Update of the Swedish two-country program of mammographic screening for breast cancer. Radiol Clin North Am 1992, 30:187�210
TABAR L. Breast cancer screening with mammography in women aged 40�49 years. Int J Cancer 1996, 68:693�699
BALDUCCI L, SCHAPIRA DV, COX CE ET AL. Breast cancer of the older woman: an annotated review. J Am Geriatr Soc 1991, 39: 1113�1123
ALLEN C, COX EB, MANTON KG. Breast cancer in the elderly: current patterns of care. J Am Geriatr Soc 1986, 34:637�642
RYBOT AH, WATERBURY L. Breast cancer in older women: trends in diagnosis. Geriatrics 1989, 44:69�82
GABRIEL H, WILSON TE, HELVIE MA. Breast cancer in women 65�74 years old: Earlier detection by mammographic screening. Am J Radiol 1996, 168:23�27
ZYTAK CJ. At what age should screenig mammography no longer be performed? 1996, 166:718
GAMBRELL RD Jr. Cancer in older women: diagnosis and prevention. Geriatrics 1988, 43:27�36
AMERICAN GERIATRICS SOCIETY POSITION STATEMENT. Screening for breast cancer in elderly women. J Am Geriatr Soc 1989, 37:883� 884
HRUBEC Z, BOISE JD, MONSON RR ET AL. Breast cancer after multiple chest fluoroscopies: second follow-up of Massachusetts women with tuberculosis. Cancer Res 1989, 49:229�234
MILLER AB, HOWE GR, SHERMAN GJ ET AL. Mortality from breast cancer after irradiation during fluoroscopic examinations in patients being treated for tuberculosis. N Engl J Med 1989, 321:1285� 1289
FEIG SA, HENDRICK RE. Radiation Risk From Screening Mammography in Women Aged 40�49 years. American Cancer Society Workshop on Guidelines for Breast Cancer Detection, Chicago IL, 1997
JACKSON VP. The current role of ultrasonography in breast imaging. Radiol Clin North Am 1995, 33:1161�1170
STELLING CB. MR imaging of the breast for cancer evaluation. Current status and future directions. Radiol Clin North Am 1995, 33:1187�1204

� 2000, ��