50歳未満受診群に対する手動超音波併用検診について Hand-Scanning Ultrasound Mass Screening for Breast Cancer in Women Aged Under 50

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15年間のUS併用検診において, 集検例は50歳未満の群でも50歳以上の群と同様に, 外来例に比して有意に良好な累積生存率を示した。また, 集検例の50歳未満と50歳以上で見ると, 乳癌発見率, 感度, 特異度はほぼ同率であるが, 50歳未満では50歳以上に比して, 要精検率, 有自覚症状率が有意に高く, 陽性予知度が有意に低かった。<BR>集検例は外来例に比して有意に腫瘤非触知が多く, 有意に小腫瘤径で, n因子, tnm病期が有意に早期を示した。組織型については, 集検例は外来例に比して非浸潤癌症例が有意に多いものの, 浸潤性乳管癌と非浸潤癌組織亜型の比率で有意差を認めなかった。これらの結果から, US併用検診が良好な生存率を示すのは乳癌を早期に検出するためであり, 悪性度の低い乳癌ばかり検出しているからではないことが示唆された。<BR>US併用検診ではUS所見のみで検出された非触知乳癌症例が26.6%を占めていた。50歳未満はその乳腺の硬さから非触知乳癌症例が30.2%を占め50歳以上に比して多く, その69.2%が浸潤癌症例であった。視触診検診のみの検診ではこれらはすべて見落とし例となるので, 厚生労働省が推奨する乳房撮影併用検診において視触診検診のみの対応とされている50歳未満の若年受診群に対して, 安全で有効なUS併用検診を導入することを提言する。

Hand-scanning ultrasound mass-screening (hereafter referred to as US screening) over the past 15 years has indicated a higher cumulative survival rate in the mass screening group than in the outpatient group in women aged both under 50 and 50 or over. The accuracy and capacity of US screening and the proportion of patients with subjective symptoms were studied for each group. We discovered that women under 50 had a significantly higher rate of "further examination needed" and "having subjective symptoms", and a significantly lower rate of "positive predictive value" than women aged 50 or over. There was no difference in the detection rate, sensitivity or specificity between the two groups.<BR>We verified that the mass screening group had a significantly higher ratio of non-palpable breast cancer, a significantly smaller tumor caliber and a significantly earlier stage in terms of n-factor and tnm-classification than the outpatient group. Although pathological investigation indicated significantly more non-invasive breast cancers in the mass screening group than in the outpatient group, we also confirmed that there was no significant difference between the two groups in the ratio of invasive ductal cancer and non-invasive cancer subtype classification. These results suggest that US screening indicates a better survival rate because it detects breast cancers earlier, not because it detects only those with lower malignancy.<BR>We verified that 26.6% of non-palpable breast cancers were detected only by US. Furthermore, we found that in women under 50, because of breast stiffness, the ratio of non-palpable breast cancers was 30.2%, which was larger than in the older age group, and of these, 69.2% were diagnosed as invasive ductal breast cancer. There is a risk that mass-screening by physical examination alone will overlook these cases, and therefore we advocate the introduction of a safe and useful US screening program for women under 50 who are currently examined by palpation only by the Japanese Ministry of Health and Welfare.

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  • 日本乳癌検診学会誌 = Journal of Japan Association of Breast Cancer Screening

    日本乳癌検診学会誌 = Journal of Japan Association of Breast Cancer Screening 13(1), 105-113, 2004-03-20

    Japan Association of Breast Cancer Screening

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各種コード

  • NII論文ID(NAID)
    10012864622
  • NII書誌ID(NCID)
    AN10398771
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    09180729
  • データ提供元
    CJP書誌  J-STAGE 
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