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对于有乳腺癌家族史或个人史、乳腺癌易感基因（BRCA）突变的无症状男性，乳腺钼靶筛查是否值得？ 2019年7月6日，施普林格·自然《乳腺癌研究与治疗》在线发表美国纽约纪念医院斯隆凯特林癌症中心、康奈尔大学威尔医学院、意大利墨西拿大学、德国法兰克福大学医院、墨西哥蒙特雷科技大学、奥地利维也纳医科大学的研究报告，探讨了乳腺钼靶筛查对于乳腺癌高风险无症状男性人群的作用。 该单中心回顾研究由伦理审查委员会批准，符合《健康保险便利和责任法案》，通过电子病历对2011年9月～2018年7月接受数字化乳腺钼靶检查的827例男性患者乳腺钼靶检查记录和临床数据进行分析。其中，出现肿块、疼痛或乳头溢液的664例患者被剔除。其余163例无症状男性有乳腺癌家族史和（或）个人史或BRCA已知种系突变并接受过乳腺钼靶筛查。 结果，163例无症状男性（年龄：平均63岁，范围24～87岁）共接受806次乳腺钼靶筛查。其中，有乳腺癌个人史125例（77%）、有乳腺癌家族史72例（44%），已知突变携带者24例（15%）：BRCA1突变4例（17%）、BRCA2突变20例（83%）。 乳腺钼靶筛查结果阴性（BI-RADS为1或2类）792次（98%），BI-RADS为3类10次（1.2%）随访时最终降为2类。乳腺钼靶异常（BI-RADS为4或5类）4次（0.4%），均为恶性。该队列乳腺癌钼靶检出率为4.9‰。 因此，根据该研究结果，该队列乳腺钼靶筛查乳腺癌检出率为4.9‰，接近平均风险女性人群乳腺钼靶筛查乳腺癌检出率，表明乳腺钼靶筛查对于乳腺癌高风险男性患者有价值。 Breast Cancer Res Treat. 2019 Jul 6. Mammographic screening in male patients at high risk for breast cancer: is it worth it? Maria Adele Marino, Ayca Gucalp, Doris Leithner, Delia Keating, Daly Avendano, Blanca Bernard-Davila, Elizabeth A. Morris, Katja Pinker, Maxine S. Jochelson. Memorial Sloan Kettering Cancer Center, New York, USA; University of Messina, Messina, Italy; Weill Cornell Medical College, New York, USA; University Hospital Frankfurt, Frankfurt, Germany; ITESM Monterrey, Monterrey, Mexico; Medical University of Vienna, Vienna, Austria. PURPOSE: To investigate the utility of mammography for breast cancer screening in a population of males at increased risk for breast cancer. METHODS: In this HIPAA-compliant institutional review board-approved single-institution study, mammography records and clinical data of 827 male patients who underwent digital mammography from September 2011-July 2018 were analyzed via the electronic medical record. 664 of these men presented with masses, pain, or nipple discharge and were excluded from this study. The remaining 163 asymptomatic men with familial and/or personal history of breast cancer, or with a known germline mutation in BRCA, underwent screening mammography and were included in this analysis. RESULTS: 163 asymptomatic men (age: mean 63 years, range 24-87 years) underwent 806 screening mammograms. 125/163 (77%) had a personal history of breast cancer and 72/163 (44%) had a family history of breast cancer. 24/163 (15%) were known mutation carriers: 4/24 (17%) BRCA1 and 20/24 (83%) BRCA2. 792/806 (98%) of the screening mammograms were negative (BI-RADS 1 or 2); 10/806 (1.2%) were classified as BI-RADS 3, all of which were eventually downgraded to BI-RADS 2 on follow-up. 4/806 (0.4%) mammograms were abnormal (BI-RADS 4/5): all were malignant. The cancer detection rate in this cohort was 4.9 cancers/1000 examinations. CONCLUSIONS: In our cohort, screening mammography yielded a cancer detection rate of 4.9 cancers/1000 examinations which is like the detection rate of screening mammography in a population of women at average risk, indicating that screening mammography is of value in male patients at high risk for breast cancer. KEYWORDS: Digital mammography; Breast cancer; Male; Screening; Diagnosis DOI: 10.1007/s10549-019-05338-1 |
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