유방암 선별검사의 최신 지견
Current opinion for breast cancer screening
1
조회
0
다운로드
7
인용
0
참고문헌
키워드
초록
유방암은 서구의 여성뿐만 아니라 한국여성에 있어서도 이제는 여성건강에 있어서 가장 중요한 문제로 부각되고 있는 질환이 다. 유방암으로 인한 사망률을 감소시키기 위해서는 효과적인 선별검사를 시행하는 것이 가장 중요한 일이다. 그러나 기존의 유방암 선별검사에 대해서는 여전히 논란의 여지가 존재한다. 유방자가검사는 유방암으로 인한 사망률 감소에 대한 효과가 불확실하나, 비침습적이고 비용이 들지 않아 여전히 추천되고 있으며, 유방 질환에 대한 관심을 높이는 효과도 기대할 수 있다. 임상유방검사의 효용성에 대해서도 아직 논란의 여지가 있으나, 약 5~10%의 유방암 환자가 유방조영술에서는 정상이 면서 임상유방검사에 의하여 처음으로 진단되는 경우가 있어 추천되고 있는 검사법이다. 유방암 선별검사의 가장 대표적인 검사법인 유방조영술은 40대의 여성에서는 1~2년 간격으로, 50대 이상에서는 매년 시행하는 것이 추천되고 있다. 최근에는 고위험 여성에서 유방자기공명영상의 민감도가 기존의 영상에 비하여 현저히 높다는 보고가 있어, 30세 이상의 고위험 여성 에서 선별검사법으로 고려할 수 있으나, 높은 위양성도와 비용으로 인하여 평균적 위험도를 가진 여성에서는 추천되지 않는 다. 유방암 선별검사를 환자에게 적용할 때에는 각각의 환자에 대한 유방암 발생 위험도 평가와 이학적 검사를 포함한 임상 적 판단이 적절한 처치를 위해서는 무엇보다도 중요한 요소임을 명심해야 한다.
Abstract
Breast cancer has become one of the most significant health concerns not only in western countries but also in Korea. Screening is the most important method to reduce the mortality related to breast cancer. However, controversy remains about some aspects of breast cancer screening. Breast self-examination has been shown not to improve cancer-specific mortality, but it is commonly advocated as a noninvasive screen. Although the contribution of the clinical breast examination to early detection is difficult to determine, up to 10 percent of mammographically silent cancers can be detected by clinical breast examination. Major health organizations endorse mammographic screening every one to two years for women 40 years, and every year after age 50 as long as the woman is healthy. Although breast magnetic resonance imaging shows promise as a screening tool in high-risk women 30 years and older, it is not currently recommended for general screening because of high false-positive rates and costs. When applying guidelines to individual patients, risk assessment and clinical judgment including physical examination is needed to ensure appropriate management.
참고문헌 (34)
- Jemal A, "Cancer statistics, 2006", CA Cancer J Clin, 56, pp.106~130 (2006)
- "NCCN Clinical practice guidelines in oncology Breast Cancer Screening and Diagnosis Guidelines. V.1"[URL]
- Thomas DB, "Randomized trial of breast self-examination in Shanghai: final results", J Natl Cancer Inst, 94, pp.1445~1457 (2002)
- Bobo JK, "Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998", J Natl Cancer Inst, 92, pp.971~976 (2000)
- McDonald S, "Performance and reporting of clinical breast examination: a review of the literature", CA Cancer J Clin, 54, pp.345~361 (2004)
- Barton MB, "The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How?", JAMA, 282, pp.1270~1280 (1999)
- Fletcher SW, "How do women compare with internal medicine residents in breast lump detection? A study with silicone models", J Gen Intern Med, 4, pp.277~283 (1989)
- Saslow D, "Clinical breast examination: practical recommendations for optimizing performance and reporting", CA Cancer J Clin, 54, pp.327~344 (2004)
- American College of Radiology, "Breast Imaging Reporting and Data System (BI-RADS®) mammography" (2003), Virginia American College of Radiology
- Bassett L, "Stereotactic core-needle biopsy of the breast: a report of the Joint Task Force of the American College of Radiology, American College of Surgeons, and College of American Pathologists", CA Cancer J Clin, 47, pp.171~190 (1997)
- Carney PA, "Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography", Ann Intern Med, 138, pp.168~175 (2003)
- Kerlikowske K, "Positive predictive value of screening mammography by age and family history of breast cancer", JAMA, 270, pp.2444~2450 (1993)
- Pisano ED, "Diagnostic performance of digital versus film mammography for breast-cancer screening", N Engl J Med, 353, pp.1773~1783 (2005)
- Teh W, "The role of ultrasound in breast cancer screening. A consensus statement by the European Group for Breast Cancer Screening", Eur J Cancer, 34, pp.449~450 (1998)
- Kuhl CK, "Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer", J Clin Oncol, 23, pp.8469~8476 (2005)
- Warner E, "Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination", JAMA, 292, pp.1317~1325 (2004)
- Leach MO, "Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS)", Lancet, 365, pp.1769~1778 (2005)
- Kriege M, "Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition", N Engl J Med, 351, pp.427~437 (2004)
- Lawrence WF, "Serendipity in diagnostic imaging: magnetic resonance imaging of the breast", J Natl Cancer Inst, 90, pp.1792~1800 (1998)
- Saslow D, "American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors", CA Cancer J Clin, 57, pp.7~28 (2007)
- Schillaci O, "Scintimammography for the detection of breast cancer", Expert Rev Med Devices, 2, pp.191~196 (2005)
- Benard F, "Imaging in breast cancer: Single-photon computed tomography and positron-emission tomography", Breast Cancer Res, 7, pp.153~162 (2005)
- Liberman M, "Breast cancer diagnosis by scintimammography: a meta-analysis and review of the literature", Breast Cancer Res Treat, 80, pp.115~126 (2003)
- "16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer", Lancet, 353, pp.1909~1914 (1999)
- Bhatia S, "Breast cancer and other second neoplasms after childhood Hodgkin’s disease", N Engl J Med, 334, pp.745~751 (1996)
- Aisenberg AC, "High risk of breast carcinoma after irradiation of young women with Hodgkin’s disease", Cancer, 79, pp.1203~1210 (1997)
- Gail MH, "Projecting individualized probabilities of developing breast cancer for white females who are being examined annually", J Natl Cancer Inst, 81, pp.1879~1886 (1989)
- "Statement of the American Society of Clinical Oncology: genetic testing for cancer susceptibility, Adopted on February 20, 1996", J Clin Oncol, 14, pp.1730~1736 (1996)
- Ciatto S, "The value of routine cytologic examination of breast cyst fluids", Acta Cytol, 31, pp.301~304 (1987)
- Barnes AB, "Diagnosis and treatment of abnormal breast secretions", N Engl J Med, 275, pp.1184~1187 (1966)
- Kleinberg DL, "Galactorrhea: a study of 235 cases, including 48 with pituitary tumors", N Engl J Med, 296, pp.589~600 (1977)
- Dawes LG, "Ductography for nipple discharge: no replacement for ductal excision", Surgery, 124, pp.685~691 (1998)
- Urban J, "Non-lactational nipple discharge", CA Cancer J Clin, 28, pp.130~140 (1978)
- Riodan J, "Anatomy and physiology. In Breastfeeding and human lactation", pp.93~119 (1999), Jones and Bartlett Publishers