基于风险的每年乳腺癌查:WISDOM随机临床试验
Laura J Esserman1, Allison S Fiscalini1, Arash Naeim2
1University of California, San Francisco.
JAMA
|December 12, 2025
概括
基于风险的乳腺癌查将女性按遗传风险和查强度分层. 虽然这种方法是安全的,但与每年进行的乳房检查相比,它并没有降低活检率.
科学领域:
- 癌症学
- 遗传学
- 预防医学
背景情况:
- 个体乳腺癌风险评估可以优化查策略.
- 目前的查方法可能无法有效地分配资源给高风险的个人.
研究的目的:
- 评估基于风险的乳腺癌查是否可行,作为每年进行乳房检查的替代方案.
- 确定风险分层是否可以改善查结果.
主要方法:
- 一项实用的多中心随机临床试验将基于风险的查与年龄在40-74岁的女性的乳房检查进行了比较.
- 风险评估包括基因测序,多基因风险评分和验证的风险模型.
- 根据计算的5年风险和遗传因素,查建议有所不同.
主要成果:
- 与年度查相比,基于风险的查在检测 ≥IIB 癌症方面没有劣势,但并没有降低活检率.
- 在基于风险的组中进行的乳房影像较少,但活检率并没有显著下降.
- 癌症发病率,活检,乳房影像和核磁共振成像率随着风险较高而增加.
结论:
- 基于风险的乳腺癌查,包括基因检测,有效分层的风险和查强度.
- 这种方法并没有降低活检率.
- 可能需要进一步的研究来优化基于风险的查方案,以减少不必要的活检.
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