台灣的乳癌

Breast Cancer in Taiwan

季瑋珠(Wei-Chu Chie) ； 黃俊升(Chiun-Sheng Huang) ； 張金堅(King-Jen Chang)

《中華公共衛生雜誌》 16卷1期 (1997/02) Pp. 62-76

https://doi.org/10.6288/CJPH1997-16-01-06

摘要

臺灣的乳癌發生率及死亡率逐年上升，重要性日益增加。已有的流行病學研究顯示都市、北部地區、外省籍、未婚者、高社經地位、初經早、生育子女數少、初次懷孕較晚、50歲以後體重較重者，罹患乳癌的危險性較高。停經與是否哺乳對乳癌的危險性沒有顯著的影響。病理學方面，乳癌多發生於乳房的外上區，經常有皮膚變化，顯微鏡下最常見者為浸潤性線管癌(infiltrating ductal carcinoma)。臨床表徵方面最常見者為無痛性乳房腫塊，腋下淋巴結腫大，乳頭凹陷，乳頭異常分泌，皮膚橘皮化或下陷等。檢查與診斷方面，大多乳癌為由病人自己發現，但由於國人認知不足，治療時只有19.7%小於或等於2公分。正確的乳房自我檢查應為目前婦女衛生教育的重點。乳癌的診斷方法有乳房X光攝影、超音波乳房檢查、細針抽取細胞檢查等，國內已有的研究顯示超音波乳房檢查敏感度、精確度往往高達80%以上，並不遜於乳房X光攝影；而細針抽取細胞檢查更可直接觀察細胞的變化，降低偽陽性及偽陰性率，幾乎可作為確診工具。乳癌的治療國內目前以修正式的乳房根除術為主，局部切除之保守療法輔以放射線治療，亦有許多醫院在嘗試進行。輔助療法則包括放射線治療（五週內給予4500-5000cGy）、化學治療（CAF，CMF等）、與荷爾蒙治療（tamoxifen，荷爾蒙接受器陽性者效果較佳）。預後方面，第一期的五年存活率高達92.9%，第二期80.5%，第三期48.5%，第四期18.5%；合併手術化學和荷爾蒙治療之五年和十年之局部復發率分別為14±2%與23±4%，唯追蹤流失較多，對預後可能有所高估。腫瘤荷爾蒙接受器、增殖能力、DNA倍子數、淋巴腺轉移的情形是預後之重要影響因素。乳癌之治療因涉及婦女之身體形象，除手術後之身體復健外，心理復健與壓力調適亦為重要課題。根據已有研究的回顧，吾人建議對婦女進行乳癌預防及乳房自我檢查之衛生教育，並對50歲以上婦女每年進行一次乳癌篩檢，在治療上訂定標準化之治療方式，並進行更深入之乳癌之流行病學、篩檢、治療等之本土性研究。

關鍵字

乳癌

並列摘要

The incidence and mortality of breast cancer is increasing in Taiwan. Previous epidemiologic studies found that the following women have higher risks: those living in urban area, northern part of the country, Mainlanders, unmarried, having high socioeconomic status, early menarche, low parity, late first full term delivery, and higher body weight after 50 years. Pathologically, breast cancers are more likely to develop at the upper outer quadrant of the breast. Infiltrating ductal carcinoma is the most frequent microscopic finding. Clinically painless mass, axillary lymph nodes enlargement, depressed nipples, abnormal nipple discharge, and skin change are most common appearances. As a result of inadequate knowledge, tumor sizes are usually large when the patients were treated. Only 19.7% of the tumors were not more than 2cm. From previous studies, the sensitivity and specificity of breast sonography are not less than mammography. Fine needle aspiration cytology can get the tissue directly, and has high sensitivity and specificity. It can be viewed as a confirmative diagnostic tool. Modified radical mastectomy is the main stream of breast cancer treatment. Conservative surgery combined with radiotherapy also showed rather good result in early stages. Adjunct therapy includes radiotherapy, chemotherapy and hormone therapy. The prognosis of breast cancer depends on stages. The five-year survival rates of the first to the fourth stage are: 92.9%, 80.5%, 48.5%, and 18.5%. Five- and ten- year local recurrence rates of combined therapy are 14±2% and 23±4%. These rates might be underestimated because of a large number of loss of follow-ups. Hormone receptor concentration, proliferative capacity, DNA aneuploid, and lymph node metastasis are important predictors of prognosis. In addition to physical treatment and rehabilitation, psychological rehabilitation and stress coping are also very important for this disease because of its influence on women's body image. According to the literature reviewed, the authors suggested to promote BSE education, to perform periodic breast cancer screening for women above 50, to establish standardized treatment protocol, and to do more researches on epidemiology, screening and treatment of breast cancer in Taiwan.

並列關鍵字

breast cancer