乳腺癌的预防 [自动保存]

Breast Cancer: Diagnosis 乳腺癌：诊断,Objectives 目标：, List the symptoms of a breast cancer patient 列出乳腺癌患者的症状 Describe screening and diagnostic procedures 描述筛查和诊断程序 Explain how mammography is used to diagnose breast cancer 释如何用于诊断乳腺癌的乳房x光检查,DIAGNOSTIC PROCEDURES 诊断程序Physical Examination 体格检查In most cases, breast cancer presents as a lump.7 To determine whether the lump (or laboratory investigation in the breast) indicates malignancy, fine needle aspiration, biopsy, and laboratory investigation are used.在大多数情况下,乳腺癌表现为肿块。是否确定肿块为恶性肿瘤, 要通过细针吸取细胞学检查(FNAC),和实验室研究（国际学术期刊）。,Signs that indicate a lump may be malignant include:迹象表明一个肿块可能是恶性肿瘤包括：1) Findings of a radiological opacity (microcalcification) with radiating fibrous strands 发现辐射不透明度(钙化)辐射纤维链2) Other changes within the breast that are noticed by the patient 引起患者注意的乳房内的其他变化3) Signs of locally advanced or metastatic disease, including a large mass, tethering to the skin and/or chest wall, lymph node enlargement, peau dorange, nipple inversion, and skin infiltration。局部晚期或转移性疾病的迹象，包括一个大肿块，贴附于皮肤或胸壁，淋巴结肿大,呈现红斑,乳头内陷和皮肤侵润。,Data from a large randomized trial of breast self-examination (BSE) screening has shown that instruction in BSE has no effect on reducing breast cancer mortality.21 Nevertheless, women should be encouraged to be aware of their breasts since this may facilitate detection of interval cancers between routine screenings by a physician. 现阶段的实验随访中没有发现乳腺自检对降低乳腺癌死亡率有何益处。所以女性的乳腺自我检查仍可作为一项常规的乳腺癌筛查手段。,Not all women having breast cancer present with a lump. Other possible presenting signs and symptoms include: 不是所有女性有肿块的就称之为乳腺癌，其他可能呈现的症状和体征体现为： Breast pain or tenderness 乳房疼痛或压痛 Change in breast shape or size 乳房形状或大小的改变 Dimpling, flaking, or thickening of the skin on the breast 凹陷、脱落或乳 房皮肤增厚 Redness or warmth of the breast 乳腺乘红色或发热 Peau dorange 呈现红斑 Nipple inversion, rash, or discharge; and 乳头内陷，红肿或有无分泌物 Swelling of the upper arm or in the armpit. 上臂或腋窝有无肿胀,乳腺自我检查 （BSE）乳腺自我检查是一项以检查者为中心 ,简便易行、无需花费、安全无创的检查方法 。检查者可以自己实施 ，无需任何设备支持。美国癌症协会（ACS）在2003 年发布的新的乳腺癌普查指南中建议：从20岁开始，应告知女性乳房自我检查(BSE)的益处和局限性。应该强调及时向健康专家报告任何新的乳房症状的重要性。选择乳房自我检查的女性应接受指导和在定期体检时让医生检查她们的手法是否正确。女性也可选择不做或不定期做乳房自我检查2.乳腺自我检查的优缺点：乳腺自我检查给妇女提供了一个认识乳房的机会 ，使妇女们增强了乳房保健意识 ，并促使她们一旦发现乳房肿块就去医院检查。但过去 20 多年来 ,美国、 加拿大、 俄罗斯、 英国、 日本和中国都先后开展了关于乳腺自我检查的研究 ，加拿大预防卫生保健组织在比较了来自这些国家的7个国际性研究报告后发现 ，实施乳腺自检与不实施乳腺自检的妇女在乳腺癌的病死率上没有差别 ，肿瘤在诊断时的分期和大小也无统计学意义。相反 ，干预组的良性病变的活检率明显高于对照组 ，就医率也大大提高。从而得出结论 ,乳腺自我检查有害无益3 。,DIAGNOSTIC PROCEDURES诊断程序 Mammography乳房x光检查Introduction 介绍A mammogram is an X-ray image of the breast. The procedure used to generate a mammogram is termed a mammography.30 Mammography can detect tumors at an early stage, when they are still small and cant be detected by palpation.31 Based on fair evidence, screening mammography in women aged 40 to 70 years decreases breast cancer mortality.32,33 The benefit is higher for older women, in part because their breast cancer risk is higher.34 乳房x光片是乳腺癌的x射线图像。程序用于生成一个乳房x光检查称为一个乳房x光检查。在早期阶段乳房x光检查可以检测肿瘤,当他们还小,不能被触诊。基于公平的证据,年龄在40-70岁的女性通过筛查性乳房x光检查降低乳腺癌死亡率。尤其针对年长者,部分原因是他们患乳腺癌的风险高。,Transcript 记录Screening by mammography can detect small tumors before there is any nodal involvement. This technique is therefore an effective tool for early detection of breast cancer. On a mammogram, breast carcinomas typically display fine calcification and areas of irregularity. Occasionally, fixation of deep lesions, either to the chest wall or skin, can also be seen.35 There are several advantages to using mammography as a screening technique: 小的肿瘤筛查通过乳房x光检查可以发现之前有任何节点参与。这种技术是早期发现乳腺癌的一种有效工具。乳房x光检查,乳房癌通常显示钙化和不规则的地方。偶尔,深层病灶,固定胸壁或皮肤,也可以看到。使用乳房x光检查作为筛查技术有如下几个优势:, The ability of mammography to detect cases much earlier than physical examination is well established.36 Technical advances have enhanced the utility of mammography in recent years by providing increased visualization of the breast parenchyma while using lower doses of X- ray radiation.37 Combined with clinical examination, mammography can be at least 90% accurate in its diagnosis. It should be noted, however, that the success of low-radiation mammography depends largely on the quality of interpretation.38 乳房x光检查检测比体格检查更早。技术进步近年来加强了乳房X光检查的应用提供可视化的乳腺实质而增加使用低剂量的X -射线辐射。结合临床检查,乳房x光检查至少达到90%准确的诊断。然而,值得注意的是,低辐射乳房x光检查的成功很大程度上取决于interpretation的质量, The finding that screening reduces breast cancer mortality has important implications regarding the onset and progression of the disease. Evidence suggests that metastases occur very early in the course of the disease and that breast cancer should be considered a systemic disease from its outset. Therefore, the reduction in breast cancer mortality by screening, an estimated 10% to 30% reduction, provides compelling evidence that early diagnosis and treatment of breast cancer can avert the onset of metastasis. 筛查可降低乳腺癌的死亡率对疾病的发病和进展有重要意义。证据表明,转移病灶发生在发病早期，乳腺癌应该从一开始就被认为是一种全身性疾病。因此,通过筛查能够降低乳腺癌的死亡率达10%到30%,提供了令人信服的证据表明,乳腺癌的早期诊断和治疗可以避免转移,DIAGNOSTIC PROCEDURES 诊断程序Confirmation 确认Introduction 介绍It is important to use methods other than mammography and physical examination to confirm a diagnosis of breast cancer. These methods can be either non-invasive or invasive.除了乳房x光检查和体格检查还有其他方法来证实诊断为乳腺癌。这些方法可以是非侵入性或侵入性。,Transcript 记录Ultrasound is a non-invasive way to differentiate whether a possible tumor detected with mammography is, instead, a fluid-filled cyst. Ultrasound can also aid in the evaluation of lumps that are difficul