Breast cancer screening: controversies and future directions.
Purpose Of Review: Recent criticisms of the mature breast cancer screening trials claimed that there is no evidence that screening saves lives. This has developed into a major public controversy, causing physicians, women, and policy analysts to rethink and debate mammography-screening guidelines. W...
| Publicado en: | Current Opinion in Obstetrics & Gynecology Vol. 15; no. 1; pp. 1 - 9 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Feb2003
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105978055&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105978055 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1040872X IQV jtl: Current Opinion in Obstetrics & Gynecology issn: 1040872X maglogo: N pubinfo: dt: Feb2003 vid: 15 iid: 1 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 105978055 105978055 NLM12544495 2009786715 10.1097/00001703-200302000-00001 NLM12544495 105978055 ppf: 1 ppct: 8 formats: tig: atl: Breast cancer screening: controversies and future directions. aug: au: Retsky M Demicheli R Hrushesky W Retsky, Michael Demicheli, Romano Hrushesky, William affil: Department of Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA sug: subj: Breast Neoplasms Prevention and Control Health Screening Standards Mammography Standards Adult Aged Breast Neoplasms Epidemiology Demography Female Forecasting Health Screening Trends Incidence Mammography Trends Middle Age Risk Assessment Sensitivity and Specificity Survival United States Human Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female ab: Purpose Of Review: Recent criticisms of the mature breast cancer screening trials claimed that there is no evidence that screening saves lives. This has developed into a major public controversy, causing physicians, women, and policy analysts to rethink and debate mammography-screening guidelines. We have studied this subject from a different perspective -- using computer simulation to fit a simple growth model to clinical data. We can thus provide another viewpoint of the screening controversy that may help elucidate the underlying biology and aid policy makers in devising sound screening guidelines.Recent Findings: We agree with some reviewers that there is partial validity to the criticism. Based on our studies, we have arrived at a new explanation of why screening has not lived up to expectations.Summary: Our fundamental hypothesis is that breast cancers often undergo periods during which they are temporarily dormant. In addition, surgical intervention to remove primary tumors can interrupt this dormancy. Therefore screening finds smaller tumors with fewer positive lymph nodes, which is beneficial. But then the resulting extirpation accelerates the growth of dormant distant micrometastases, and results in earlier relapses than in women who have not been screened. This partly offsets the early detection advantage. One hypothetical mechanism proposed to explain this biology is that surgical wounding, particularly for premenopausal node-positive patients, can trigger the angiogenesis of dormant avascular micrometastases. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|