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Int J Cancer：早筛悖论！国际癌症杂志证明，乳腺癌筛查不能降低死亡率

2018-09-17 探索菌 生物探索

乳腺癌早期筛检过度诊断
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来自丹麦和挪威的一项研究表明，近年来死于乳腺癌的女性越来越少，但令人惊讶的是，在未接受筛查的年龄组中，这一下降幅度也同样大。因此，死亡率的下降是由于更好的治疗，而非乳腺癌筛查，即乳腺癌筛查并不能降低患者死亡率。

来自丹麦和挪威的一项研究表明，近年来死于乳腺癌的女性越来越少，但令人惊讶的是，在未接受筛查的年龄组中，这一下降幅度也同样大。因此，死亡率的下降是由于更好的治疗，而非乳腺癌筛查，即乳腺癌筛查并不能降低患者死亡率。

这一研究于近日以“Effect of organised mammography screening on breast cancer mortality： A population‐based cohort study in Norway”为题发表在《International Journal of Cancer banner》杂志。

具体来说，在这项研究中，作者之一、丹麦奥尔胡斯大学Henrik St？vring教授及其团队跟踪了所有30 - 89岁的挪威妇女，并确定了1987 - 2010年期间患乳腺癌的人，随后比较了筛查方案实施前后的死亡人数。

正如作者指出的那样，乳腺癌筛查与死亡率降低的关系微乎其微。“我们并没有发现乳腺癌筛查的有益效果，” Henrik St？vring说，“早在1980年代，研究乳腺癌筛查的最初随机试验就开始了，且显示出积极效果，但事实是，随着治疗方法越好，筛查的益处就越小”。

01.早筛不能延长寿命

在新研究中，他还指出了筛查的一个悖论，即一种流行却错误的信念——如果被筛查的乳腺癌患者比其他乳腺癌患者“活得更长”，那么筛查是有效的。而事实却是，尽管医生通过筛查发现患者体内肿瘤的时间早于原本会发现的时间，从而使诊断时间提前，但是即使被筛查者作为病人的寿命更长，也不代表他们的整体寿命会更长。新的研究表明筛查不会导致女性总体寿命延长。


图片来源：jovannig / Fotolia

作者解释，受邀接受筛查的女性之所以活得更长，是因为所有乳腺癌患者都活得更长，这得益于我们现有更好的药物及更有效的化疗；此外，与十年前相比，我们的癌症护理流程更好，医疗保健系统更完善。然而，结果显示并没有因为乳房X光检查而导致较少的妇女死于乳腺癌。”

他还指出，在乳房X光检查中，女性被诊断出微小的癌性生长，例如直径一毫米，并不总是有益的。其中一些小结节生长缓慢，如果没有进行筛查的话，该患者会死于所谓的癌症自然死亡。

“而现在发生的事情是，这些诊断会导致女性更不快乐。这种乳腺癌的诊断不仅使生活更加困难，而且花费了很多钱，但最终并没有带来什么不同。问题是，我们目前还不能区分致死和非致死的小肿瘤。”

02.过度诊断带来潜在危害

作者在研究中还谈到了过度诊断的问题。这是所有西方国家日益严重的问题，在这些国家，医疗和检查方法广泛，国家筛查方案普遍存在。尽管研究结果挑战了丹麦、挪威和其他西方国家的现行卫生政策，但Henrik St？vring并没有告诉丹麦政治家，他们现在应该停止国家筛查计划。

“当然，我的任务不是决定如何使用研究成果，而是建议我们应该团结起来，调查除了筛选之外做点别的事情是否有益，以及是否会带来更好的效果。如果医生可以用手定期检查女性的乳房（也就是所谓的触诊），那么我们就可以避免很多过度诊断。”作者总结。

原始出处：Møller MH,  Lousdal ML,  Kristiansen IS,  Støvring H.  Effect of organised mammography screening on breast cancer mortality: A population-based cohort study in Norway. Int J Cancer. 2018 Aug 25.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1455968, encodeId=9cd3145596825, content=<a href='/topic/show?id=d1fc23e69b7' target=_blank style='color:#2F92EE;'>#乳腺癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23769, encryptionId=d1fc23e69b7, topicName=乳腺癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53d75754638, createdName=ay2002fy, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456899, encodeId=0d7a14568996c, content=<a href='/topic/show?id=7de159498d1' target=_blank style='color:#2F92EE;'>#早筛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59498, encryptionId=7de159498d1, topicName=早筛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a10e5815774, createdName=nakerunner, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345466, encodeId=bb33345466ec, content=认真学习，不断进步，把经验分享给同好。点赞了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Tue Sep 18 08:34:58 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345454, encodeId=72c434545472, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 18 08:13:09 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345438, encodeId=4cf33454386e, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Tue Sep 18 07:26:23 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345428, encodeId=44433454283c, content=嗯嗯，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Tue Sep 18 06:47:04 CST 2018, time=2018-09-18, status=1, ipAttribution=)]
    2018-09-19 ay2002fy

    #乳腺癌筛查#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1455968, encodeId=9cd3145596825, content=<a href='/topic/show?id=d1fc23e69b7' target=_blank style='color:#2F92EE;'>#乳腺癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23769, encryptionId=d1fc23e69b7, topicName=乳腺癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53d75754638, createdName=ay2002fy, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456899, encodeId=0d7a14568996c, content=<a href='/topic/show?id=7de159498d1' target=_blank style='color:#2F92EE;'>#早筛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59498, encryptionId=7de159498d1, topicName=早筛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a10e5815774, createdName=nakerunner, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345466, encodeId=bb33345466ec, content=认真学习，不断进步，把经验分享给同好。点赞了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Tue Sep 18 08:34:58 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345454, encodeId=72c434545472, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 18 08:13:09 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345438, encodeId=4cf33454386e, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Tue Sep 18 07:26:23 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345428, encodeId=44433454283c, content=嗯嗯，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Tue Sep 18 06:47:04 CST 2018, time=2018-09-18, status=1, ipAttribution=)]
    2018-09-19 nakerunner

    #早筛#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1455968, encodeId=9cd3145596825, content=<a href='/topic/show?id=d1fc23e69b7' target=_blank style='color:#2F92EE;'>#乳腺癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23769, encryptionId=d1fc23e69b7, topicName=乳腺癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53d75754638, createdName=ay2002fy, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456899, encodeId=0d7a14568996c, content=<a href='/topic/show?id=7de159498d1' target=_blank style='color:#2F92EE;'>#早筛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59498, encryptionId=7de159498d1, topicName=早筛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a10e5815774, createdName=nakerunner, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345466, encodeId=bb33345466ec, content=认真学习，不断进步，把经验分享给同好。点赞了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Tue Sep 18 08:34:58 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345454, encodeId=72c434545472, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 18 08:13:09 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345438, encodeId=4cf33454386e, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Tue Sep 18 07:26:23 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345428, encodeId=44433454283c, content=嗯嗯，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Tue Sep 18 06:47:04 CST 2018, time=2018-09-18, status=1, ipAttribution=)]
    2018-09-18 lietome15

    认真学习，不断进步，把经验分享给同好。点赞了！

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1455968, encodeId=9cd3145596825, content=<a href='/topic/show?id=d1fc23e69b7' target=_blank style='color:#2F92EE;'>#乳腺癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23769, encryptionId=d1fc23e69b7, topicName=乳腺癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53d75754638, createdName=ay2002fy, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456899, encodeId=0d7a14568996c, content=<a href='/topic/show?id=7de159498d1' target=_blank style='color:#2F92EE;'>#早筛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59498, encryptionId=7de159498d1, topicName=早筛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a10e5815774, createdName=nakerunner, createdTime=Wed Sep 19 14:38:00 CST 2018, time=2018-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345466, encodeId=bb33345466ec, content=认真学习，不断进步，把经验分享给同好。点赞了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Tue Sep 18 08:34:58 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345454, encodeId=72c434545472, content=谢谢分享，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 18 08:13:09 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345438, encodeId=4cf33454386e, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Tue Sep 18 07:26:23 CST 2018, time=2018-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345428, encodeId=44433454283c, content=嗯嗯，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Tue Sep 18 06:47:04 CST 2018, time=2018-09-18, status=1, ipAttribution=)]
    2018-09-18 明月清辉

    谢谢分享，学习了

    0

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    2018-09-18 深海的鱼

    学习学习学习

    0

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    2018-09-18 liumin1987

    嗯嗯，学习了。

    0

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