12月份的Breast Cancer Research and Treatment杂志上刊登一项新研究"Impact of mammographic screening on the detection of good and poor prognosis breast cancers"表明，在如今乳腺X线摄影筛查普及的时代，49~60岁女性中“低风险”和“超低风险”乳腺癌显著增加。作者提到，筛查如今似乎更优先确定人群中低风险的病变。该研究为低风险病变检测增加提供了第一个分子证据。
该研究使用来自荷兰的数据，比较了1984~1992年诊断确认的乳腺癌（乳腺X线摄影不是常规检测）妇女队列和2004~2006诊断确认的乳腺癌妇女队列（乳腺X线摄影筛查时代）。
对两个队列中49~60岁的妇女进行比较，前一个队列中低风险乳腺癌的比例较小（40.6%; 67 of 165），后一个队列较大（58%; 119 of 205）。
这项研究仅限于淋巴结阴性乳腺癌患者，使用荷兰癌症研究所的70-基因乳腺癌预后检测评估风险，该项测试，商业上称为MammaPrint，可以预测总体生存和远处转移的进展，也可确认超低风险的疾病。
调查者报告了2个队列中超低风险妇女的亚组人群，再次发现，随着时间推移，这类人群的人数增加。在第一个队列中，10%的49~60岁女性是超低风险乳腺癌，第二个队列中位30%。值得注意的是，在小于40岁的女性中，两个队列之间低风险疾病的比例没有显著差异。
这些结果意味着什么？作者认为应该促使乳腺癌筛查和诊疗策略的改变。他们建议，因为低侵略性的乳腺癌增加，应该有相应的针对低侵略性乳腺癌的治疗方法出现，甚至在某些情况下，有相应的诊断方法的出现。
该研究认为我们应该改善筛查，在筛查时应该引进分子检测例如MammaPrint和Oncotype DX，帮助确认低风险肿瘤，目前，这些检测用于诊断后指导治疗。
但是有一个专家不赞同在筛查时使用这些检测，将分子检测添加到筛查听起来很吸引人，Kandace McGuire说到，但是分子检测需要活组织切片，在筛查级别进行是不合适的。使用70-基因筛查技术，可以用于指导治疗而不是诊断。
尽管如此，该文的作者认为，将70-基因检测技术整合进入筛查的主要目的是为了避免过度治疗。（生物谷Bioon.com）
doi:10.1007/s10549-011-1748-z
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Impact of mammographic screening on the detection of good and poor prognosis breast cancers.
Esserman LJ, Shieh Y, Rutgers EJ, Knauer M, Retèl VP, Mook S, Glas AM, Moore DH, Linn S, van Leeuwen FE, van 't Veer LJ.
We sought to compare the molecular signature of node negative cancers from two cohorts 15 years apart, to determine if there is molecular evidence of increase in low and ultralow risk cancers over time. We studied the impact of age, time period of diagnosis, and mammographic screening on biology of tumors where The Netherlands Cancer Institute 70-gene prognosis signature was generated as part of 2 validation series, one retrospective (1984-1992), Cohort 1, and one prospective (2004-2006), Cohort 2. A total of 866 patients were analyzed. Regardless of time period of diagnosis, the proportion of T1, grade 1, hormone receptor positive (HR) tumors, and good prognosis by 70-gene signature significantly increases as age increases (P < 0.01). In women aged 49-60, the time period of diagnosis significantly affects the proportion of cancers that were NKI 70-gene low risk: 40.6% (67/165) compared with 58% (119/205) for Cohorts 1 and 2, respectively. This is in contrast to the absence of a significant change for women under age 40, where 25% (17/68) and 30% (17/56) were low risk in Cohorts 1 and 2, respectively. In women aged 49-60, using an ultralow risk threshold of the 70-gene signature, 10% of tumors in Cohort 1 were ultralow risk compared with 30% for women with screen-detected cancers in Cohort 2. Older age and method of detection (screening) are associated with a higher likelihood of a biologically low risk tumor. In women over age 50, biologically low risk tumors are frequent and tools that classify risk may minimize overtreatment.
