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1516Gotzsche Cochrane Data Base System Rev 2009 8 15-30 4049 2009USPSTF Annals Internal Medicine 2004 2004 40 69 2009 50 74 40 49 2010 45 69 National Health SystemNHS 50 70 47 73 USPSTF 50 50 USPSTF Relative Risk for NNI to prevent Breast Cancer Mortality 1 breast cancer death 95CI 95CI 40~49 0.85 1904 50~59 0.86 1339 60~69 0.68 337 70~74 1.12 N/A NNInumber need to investigate 4049 1904 6069 377 4049 dense
4049 1. density sensitivity 2. interval cancer 12 24 Breast Cancer Screening ConsortiumBCSC 329,485 AJR 1997 1691001~8 4049 40~44 65.6 45~49 69.7 4049 90 interval cancer 4049 12 odd ratio 2.3624 3.58 24 2.36 24.72 3.58 odd ratio12 5.3624 6.3 50 48 SEER 1995~2005 117,738 18 ~39 15~19 20~24 25~29 30~34 35~39 40~44 0.1 0.7 3.8 12.9 29.3 59.1 35~39 73,335 Recall Sensitivity Specificity PPV 12.7 76.6 87.5 1.3 PPVPositive Predictive Value. 1.6/1000
35~39 79 76.5 40~44 66 82.4 45~49 40 87.3 35~39 310,000 1,266 12.7 recall 16 1,250 1266161,250 false positivefp 1. 40 recall rate2.low cancer rate 10,000 16 cancer odd ratioor ORCI 95 40~49 0.5 50~59 0.54 60~69 0.65 Schoor GV EJC 2010463137~40 60~69 0.65 40~49 0.5 UK Age Trial 10,000 7~9 0.56 50 10,000 10 2 H 01Family History 01 study HS 50~70 47~73 2008 82011 9 1.50 2.40 3. 150 mammography A quality of life-qol mortality 1963 MMG.
17-30 8 RCTs 50~74 22 RR 0.78 10 lead time bias 20 lead time bias density digital mammography USPSTF 2004 B 40~49 2001 50 2001 2 mammography 40~49 B 40~49 50 MMG 8 RCTs 50 subset 40~49 10 Gothenburg 40~49 14 40~49 7 RCTs meta-analysis RR0.85 15 1991~1997 trialuk Age Trial -Moss Lancet RR0.83P0.11 40~49 USPSTF MMG. 40~49 B 2004 2009 50 MMG 40~49 45~55 2005 45 MMG. guideline 2008 3 digital mammography A Oslo I study 3,683 0.62 0.76 Oslo II 23,929 45~69 0.59 0.38P0.03 78 51 Radiology 2007244708-17 0.72vs 0.58
0.21vs 0.11 P0.001 0.68vs 0.72 3 8,000 45~55 45~50 45~69 2009 USPSTF 40 50 NHS 47~73 50~70 50 A 40~49 B 45~55 12 interval cancer 24 45 12 45~49 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;151:727-37 3. Breast Cancer Screening Consortium AJR 1997;169:1001-8 4. Buist DSM, Porter PL, Lehman C et al. Factors Contributing to Mammography Failure in Women Aged 40-49 Years. JNCI 2004;96:1432-40 5. Yankaskas BC, Haneuse S, Kapp JM et al. for the Breast Cancer Surveillance Consortium. JNCI 2010;102:692-701 6. Van Schoor G, Moss SM, Otten JDM et al. Effective biennial mammographic screening in women aged 40-49. Euro J Cancer 2010;46:3137-40 7. 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;11:1127-34 8. 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
1 30 240 ~49 556 USPSTF 1904 350 ~74 33 4 50 40 1,000 33 33 years of life 585 2 USPSTF
2009 USPSTF 1 40~49 American College of Radiology 2011 11 22 2 40~49 weak recommendationmoderatequality evidence 50~74 2~3 2011 4 Cochrane Review Nordic Cochrane Groups, Peter Gotzsche 3 19 RR 0.81 8 15~30 22 FPR overdiagnosis unnecessary biopsy James Raftery 2011 12 8 BMJ Possible net harms of breast cancer screeningupdated modelling of Forrest report Quality adjusted life yearsqalys 8 2011 2 American Journal of RadiologyAJR 40~84 39.6 15~16Cochrane Review 2011 USPSTF2009 22.3 Evidence strongly suggested the mortality benefit of annual screening mammography beginning at age 40 and the potential harms minor The Lancet 2011 11 19 27 53 8,000 2010 45~69 2011 10 26.4 1. 2. 3. 4. recall
1Nelson HD, Tyne K, Humphrey L et al. Screening for breast cancer update for USPSTF Ann Int Med 2009;151:727-37 2Canadian Medical Association Journal 2011 11 22 3Gotzsche 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;378:1775-76 Raftery J.Possible net harms of breast cancer screeningupdated modelling of Forrest report. BMJ 2011December 8 published.
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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 1898 1948 D.H. Patey Dyson Middlesex 1930~1943 118 16 10 76 4 Bernard Fisher( ) Edwin Fisher( )1957 NSABP 1980 without systemic treatmentwe cannot cure the breast cancer Samuel Hellman1980 (heterogeneity) spectrum 10~20 - (1907-1989) - (1913-1975) - (1946- )