台灣乳癌之流行病學

The Epidemiology of Breast Cancer in Taiwan

張金堅(King-Jen Chang) ； 郭文宏(Wen-Hung Kuo) ； 王明暘(Ming-Yang Wang)

《中華民國癌症醫學會雜誌》 24卷2期 (2008/04) Pp. 85-93

https://doi.org/10.6588/JCOS.2008.24.2.1

摘要

根據衛生署之統計，台灣在過去20年中乳癌之年發生率有超過4倍之快速成長，自民國九十二年起，台灣乳癌之年發生率已超過子宮頸癌而成為台灣女性發生率第一的惡性腫瘤，死亡率為第四位。歷年的乳癌發生率的趨勢在1980年為十萬分之12.7，之後緩緩上升，1985年為十萬分之16.41，而1995年為十萬分之28.68及2005年為十萬分之49。在台灣婦女中，乳癌發生率在早期的世代隨著年齡增加的速率比較慢，而在較晚期的世代增加的速率則加快，在白種美國人中乳癌隨著年齡增加的速率在每個世代相近。都市地區乳癌發生率比鄉村地區高，保持市＞鎮＞鄉的趨勢，而北、中、南、東四地理區的乳癌年齡調整發生率則是以北部最高。雖然乳房攝影已經在西方社會廣泛運用在乳癌篩檢中，在亞洲地區仍然只有有限的經驗。在1995-1998之間，在台灣多中心乳癌篩檢計劃中(TAMCAS)進行在一等親乳癌病史的婦女，接受年度的乳房攝影、超音波以及理學檢查，稱為選擇性的乳癌篩檢計畫。在1999-2001年，推行由公衛護士進行乳房理學檢查或超音波檢查。2004年以後，政府已針對50-69歲婦女全面免費進行每二年之乳房X光攝影之篩檢。這三種篩檢模式，單純理學檢查的陽性預測值為2%，選擇性乳癌篩檢計畫的陽性預測值為8%，而兩階段篩檢模式中，第二階段乳房攝影的陽性預測值為14%。由此得知在乳癌盛行率低於西方社會的台灣，使用的篩檢模式，必須能夠達到比單一模式篩檢更好的效果。在2002-2004年之中，政府決定使用乳房攝影進行乳癌篩檢。針對50-69歲，採取兩階段的模式。第一階段為問卷調查，由問卷中發現為高危險群的婦女，再進行乳房攝影。目前台灣正進行40至49歲婦女利用乳房超音波篩檢乳癌之先導性研究，以40歲至49歲之婦女是否可利用乳房超音波進行全面性之乳癌篩檢，希望不久之將來能夠看到結果。由此可知乳癌對於婦女健康是一重大威脅，所以我們要對乳癌有更進一步的認識，才能更有效而且廣泛來防治乳癌，而增進婦女的健康。

關鍵字

乳癌 ； 流行病學 ； 危險因子 ； 乳房攝影

並列摘要

According to the statistics of Department of Health in Taiwan, the incidence of breast cancer had increased 4 fold in the past twenty years. Since 2003, the incidence of breast cancer had exceeded cervical cancer and became the most common female cancer in Taiwan, and the fourth cause of female cancer death. The incidence of female breast cancer was 12.7 per 100,000 women in 1980, and then increased gradually. It was 16.41 per 100,000 women in 1985, 28.68 per 100,000 women in 1995 and 49 per 100,000 women in 2005. In Taiwanese women, the increase in breast cancer incidence with increasing age was slower in earlier cohorts of early birth cohort, and the increase became faster in the later birth cohort. For Caucasian women, the increase in breast cancer incidence with increasing age seemed similar between earlier and later cohorts. Urban area had higher incidence than the rural area and northern part of Taiwan had the highest incidence. Although mammographic screening had been widely practiced in Western countries, there is only limited experience in Asian area. Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The positive predictive value was 2% for physical examination and 8% for selective screening. Two-stage mammography screening had the most favorable results compared with the two previous screening regimens. It had 14% positive predictive value. For a low-to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies. Currently there is a pilot study of breast cancer screening by sonography in 40-49 year-old women in Taiwan and we could obtain the result in near future. Breast cancer is a major threat of woman health in Taiwan. We need to learn more for early detection of breast cancer, and improve the health of women in Taiwan.

並列關鍵字

breast cancer ； epidemiology ； risk factors ； mammography