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4 ? polyphenols catechin 30 3 cohort study4 case-control study4 (meta-analysis) (systematic review) cohort study case-control study meta-analysis (WCRF) (AICR)

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23 1516Gotzsche Cochrane Data Base System Rev USPSTF Annals Internal Medicine National Health SystemNHS USPSTF USPSTF Relative Risk for NNI to prevent Breast Cancer Mortality 1 breast cancer death 95CI 95CI 40~ ~ ~ ~ N/A NNInumber need to investigate dense

24 density sensitivity 2. interval cancer Breast Cancer Screening ConsortiumBCSC 329,485 AJR ~ ~ ~ interval cancer odd ratio odd ratio SEER 1995~ , ~39 15~19 20~24 25~29 30~34 35~39 40~ ~39 73,335 Recall Sensitivity Specificity PPV PPVPositive Predictive Value. 1.6/1000

25 35~ ~ ~ ~39 310,000 1, recall 16 1, ,250 false positivefp recall rate2.low cancer rate 10, cancer odd ratioor ORCI 95 40~ ~ ~ Schoor GV EJC ~40 60~ ~ UK Age Trial 10,000 7~ , H 01Family History 01 study HS 50~70 47~ mammography A quality of life-qol mortality 1963 MMG.

26 RCTs 50~74 22 RR lead time bias 20 lead time bias density digital mammography USPSTF 2004 B 40~ mammography 40~49 B 40~49 50 MMG 8 RCTs 50 subset 40~49 10 Gothenburg 40~ ~49 7 RCTs meta-analysis RR ~1997 trialuk Age Trial -Moss Lancet RR0.83P ~49 USPSTF MMG. 40~49 B MMG 40~49 45~ MMG. guideline digital mammography A Oslo I study 3, Oslo II 23,929 45~ P Radiology vs 0.58

27 0.21vs 0.11 P vs ,000 45~55 45~50 45~ USPSTF NHS 47~73 50~70 50 A 40~49 B 45~55 12 interval cancer ~49 Reference: 1. Gotzsche P, Nielsen M. Screening for breast cancer with mammography (Review) Cochrane Data Base System Review. 2009,issue 4 2. Nelson HD, Tyne K, Humphrey L. et al Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Int Med 2009;151: Breast Cancer Screening Consortium AJR 1997;169: Buist DSM, Porter PL, Lehman C et al. Factors Contributing to Mammography Failure in Women Aged Years. JNCI 2004;96: Yankaskas BC, Haneuse S, Kapp JM et al. for the Breast Cancer Surveillance Consortium. JNCI 2010;102: Van Schoor G, Moss SM, Otten JDM et al. Effective biennial mammographic screening in women aged Euro J Cancer 2010;46: FH01 collaborative teams. Mammographic surveillance in women younger than 50 years who have a family history of breast cancer: tumor characteristics and projected effect on mortality in the prospective, single-arm, FH01 study.the Lancet Oncol 2010;11: Japanese Breast Cancer Society. Examination and Diagnosis, Guidelines 2008;4-7. Kanehara publishing co, Tokyo. 9. Japanese Breast Cancer Society. Examination and Diagnosis, Guidelines 2008;4-7. Kanehara publishing co.2010

28 ~ USPSTF ~ , years of life USPSTF

29 2009 USPSTF 1 40~49 American College of Radiology ~49 weak recommendationmoderatequality evidence 50~74 2~ Cochrane Review Nordic Cochrane Groups, Peter Gotzsche 3 19 RR ~30 22 FPR overdiagnosis unnecessary biopsy James Raftery BMJ Possible net harms of breast cancer screeningupdated modelling of Forrest report Quality adjusted life yearsqalys American Journal of RadiologyAJR 40~ ~16Cochrane Review 2011 USPSTF Evidence strongly suggested the mortality benefit of annual screening mammography beginning at age 40 and the potential harms minor The Lancet , ~ recall

30 1Nelson HD, Tyne K, Humphrey L et al. Screening for breast cancer update for USPSTF Ann Int Med 2009;151: Canadian Medical Association Journal Gotzsche PC, Nielson M. Screening for the breast with mammography (Review) The Cochrane Review 2011, issue 4. 4Hedrick RE, Helvie MA. U.S. Public Services Task Force Screening Mammography Recommendations, Science Ignored. AJR 2011;196(2); 5Bock K, Borishe B, Cawson J. et al. Effect of population-based screening on breast cancer mortality. The Lancet 2011;378: Raftery J.Possible net harms of breast cancer screeningupdated modelling of Forrest report. BMJ 2011December 8 published.

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39 2 ER, PR, HER-2

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44 Afterword 1967 Dr. T. C. Greco, Rembrandt Hendrickje Stoffels Bathsheba Greco Stoffels Greco Attosa 409 Babylon There is no treatment for bulging tumor ( 548 A.D.Aetios of Amide Byzantium Theodora Surgery was the only answeri make the patient lie downthen I incise the healthy part of the breast beyond the cancerous areas and I cauterize the incised partsremove all of the disease tissue, otherwise the cancer would recur Theodora 548 A.D.6 Henri Le Dran 1757 William S. Halsted D.H. Patey Dyson Middlesex 1930~ Bernard Fisher( ) Edwin Fisher( )1957 NSABP 1980 without systemic treatmentwe cannot cure the breast cancer Samuel Hellman1980 (heterogeneity) spectrum 10~20 - ( ) - ( ) - (1946- )

PowerPoint プレゼンテーション

PowerPoint プレゼンテーション 2015/7/23 1 3 p.23 2015 670 2010 2 WHO: Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases (2014) http://www.who.int/elena/titles/bbc/fruit_vegetables_ncds/en/ WHO: