我國乳癌篩檢攝影的醫療曝露正當性研究

A study of Justification for medical exposure in mammography screening

朱惠珍(Hui-Chen Chu)

指導教授 ： 張寶樹

高雄醫學大學/健康科學院/醫學影像暨放射科學系碩士在職專班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00072

摘要

研究背景
根據衛生福利部統計，乳癌在台灣女性癌症發生率排名第一，死亡率排第四，臨床研究證實定期接受乳癌篩檢攝影，可降低乳癌的死亡率，但我國的乳癌篩檢攝影利用率偏低，民眾未接受乳癌篩檢的原因中包含擔心輻射致癌風險而拒絕接受乳癌篩檢攝影。
研究目的
本研究探討台灣地區乳癌篩檢攝影之醫療曝露正當性，期望其結果能降低民眾對乳癌篩檢輻射風險的疑慮，進而提高受檢的意願。
材料與方法
1. 蒐集2010-2014共計5年，衛生福利部國民健康署公布之乳癌篩檢攝影相關資料，計算篩檢效益。
2. 文獻探討估算平均乳腺劑量。
3. 依據我國現行「游離輻射防護安全標準」所採用的1991年國際放射防護委員會(ICRP)第60號報告，及2007年ICRP第103號報告，計算乳癌篩檢攝影的輻射風險。
4. 評估乳癌篩檢攝影的效益(利益)及風險(代價)，以探討我國乳癌篩檢攝影的醫療曝露正當性。
結果
總檢查為3,166,547人次，乳癌偵測率為4.55±0.11‰，每次乳房篩檢攝影所造成的平均乳腺劑量為2.82毫戈雷(mGy)，輻射風險依據ICRP No.60報告及ICRP No.103報告計算，分別為8.18×10-6及9.31×10-6。
結論
我國乳癌篩檢攝影，每1,000人就有4.55人偵測出乳癌而獲得即時治療，遠高於每百萬名有8.18人(ICRP No.60)及9.31人(ICRP No.103)，可能因接受乳癌篩檢攝影而誘發乳癌，乳癌篩檢攝影的效益顯而易見，所以我國乳癌篩檢攝影符合輻射防護的正當性原則。

關鍵字

乳房攝影篩檢 ； 平均乳腺劑量 ； 正當性

並列摘要

Background
According to the statistics published by the Ministry of Health and Welfare of Republic of China (Taiwan), breast cancer is the first most common cancer in women, and the forth most common mortality relates to cancer. Periodic surveillance mammography has been proved to reduce cancer-related mortality in many previous studies. However, women undertaking regular screening mammography in Taiwan are not as common as women in other developed countries. One of the reasons behind this is the concern of radiation exposure.
Purpose
To investigate the screening mammography is justified for women in Taiwan in terms of radiation exposure.
Materials and Methods
1. Retrospective analysis of national-wide data base of surveillance
Mammography is between 2010 and 2014.
2. The paper review is used to predict the mean radiation dose of mammography
3. To predict cancer risk of radiation exposure of screening mammography, the data is based on International Commission on Radiological Protection (ICRP) Publication No.60(1991) and No.103(2007).
4. Evaluate the benefit and risk of screening mammography, and determine
the justification of screening mammography for women in Taiwan
Results
There were 3,166,547 mammography performed in Taiwan during the study period. Of them, 4.55±0.11‰ were proved to be victims of breast cancer. The mean radiation exposure of breast gland was 2.82 mGy. The estimated cancer risks based on ICRP No.60 and No.103 were 8.18×10-6 and 9.31×10-6, respectively.
Conclusion
Based on the results, 4.55 women for every 1,000 mammography were found to have breast cancer. And only 8.18 (ICRP No.60) and 9.31(ICRP No.103)cancers for a million times of mammography would be induced by the dose of radiation exposure. The benefit of mammography significantly outweighed the risk of cancer. Therefore, screening mammography is justified for women in Taiwan.

並列關鍵字

mammography screening ； average glandular dose ； justification

參考文獻

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