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題名：臺灣的乳癌
書刊名：中華公共衛生雜誌
作者：季瑋珠／黃俊升／張金堅
作者(外文)：Chie, Wei-chu／Huang, Chiun-sheng／Chang, King-jen
出版日期：1997
卷期：16:1
頁次：頁62-76
主題關鍵詞：乳癌；Breast cancer
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(4) 博士論文(0) 專書(0) 專書論文(0)
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　　　　　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 為浸潤性腺管癌（ 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 4500-5000 cGy ）、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。
　　　　　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 outr 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 2 cm. 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 wiht 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.
期刊論文
1.Cheng, Y. T.、Day, G. I.、Lin, T. M.(1984)。Secular trend of mortality of female sex organs in Taiwan。Chin Med J，34，601-607。  new window
2.Lin, T. M.、Ko, R. F.、Chen, K. P.(1970)。Cancer of the female breast: 1. some epidemiologic aspects of cancer of the breast in Taiwan。J Form os Med Assoc，69，37-47。  new window
3.Lin, T. M.、Chen, K. P.、MacMahon, B.(1971)。Epidemiologic characteristics of cancer of the breast in Taiwan。Cancer，27，1497-1504。  new window
4.Ko, R. T.(1973)。A study on age-specific: incidence and death rate of cancer of the breast in high, moderate and low rate countries。J Formos Med Assoc，72，31-38。  new window
5.Chie, W. C.、Chen, C. F.、Lee, W. C.、Lin, R. S.(1995)。Age-period-cohort analysts of breast cancer mortality。Anticancer Research，15，511-516。  new window
6.Chie, W. C.、Chen, C. F.、Chen, C. J.、Chang, C. L.、Liaw, Y. P.、Lin, R. S.(1995)。Geographic variation of breast cancer in Taiwan: international and migrant comparison。Anticancer Research，15，2745-2750。  new window
7.Lin, T. M.、Ko, R. T.、Chen, K. P.(1970)。Cancer of the female breast 2: marriage and fertility in cancer of the breast。J Formos Med Assoc，69，164-173。  new window
8.Chie, W. C.、Chen, C. F.、Lee, W. C.、Chen C. J.(1996)。Socioeconomic status, lactation and breast cancer risk of parous women in Taiwan。Oncology Reports，3，497-501。  new window
9.MacMahon, B.、Cole, P.、Lin, T. M.(1970)。Age at first birth and breast cancer risk。Bull Wld Hlth Org，43，209-221。  new window
10.MacMahon, B.、Lin, T. M.、Lowe, C. R.(1970)。Lactation and cancer of the breast: a summary of an international study。Bull Wld Hlth Org，42，185-194。  new window
11.Chie, W. C.、Chen, C. F.、Lee, W. C.、Chen, C. J.(1996)。Body size factor and breast cancer risk in Taiwan。Anticancer Research。  new window
12.Wang, S. M.、Chen, Y. H.、Chen, K. M.(1971)。Carcinoma of the breast。J Surg Assoc ROC，4(2)，71-83。  new window
13.Kuo, S. J.、Wang, C. C.、Liu, T. C.(1981)。Inflammatory carcinoma of the breast。J Surg Assoc ROC，14，28-33。  new window
14.黃天祥、王德錦、史濟青(1987)。女性乳房之Paget氏疾病。中華外科誌，20，438-441。  延伸查詢new window
15.Yang, P. S.、Wang, T. C.、Yang, Y. L.(1992)。Analysis of breast cancer and cancer invasion of the nipple-areola。J Surg Assoc ROC，25，957-962。  new window
16.Yu, S. C.、Lm, P. W.、Liaw, K. Y.(1985)。Fine needle aspiration cytology of breast tumors。J Formos Med Assoc，84，727-734。  new window
17.Kuo, S. H.、Lin, C. C.、Yu, S. C.(1985)。Relationship of DNA ploidy, cell kinetics, estrogen receptor and clinical status in patients with breast cancer。J Formos Med Assoc，84，1260-1269。  new window
18.Liu, Y. C.、Chang, T. M.、Chen, V. T. K.(1986)。Signet-ring cell carcinoma of the breast--case report。J Surg Assoc ROC，19，284-291。  new window
19.王德錦、楊博勝、楊圳隆、鄭國祥(1991)。乳癌病患腋下淋巴轉移分布狀態之分析。中華外科誌，24，835-840。  延伸查詢new window
20.Kuo, S. J.、Wang, C. C.、Liu, T. C.(1981)。Cancer of the male breast--a review of 17 cases。J Formos Med Assoc，80，5223-5529。  new window
21.葉俊廷、田郁文、張金堅(1993)。男性乳癌。台灣醫誌繼續教育，3(2)，232-239。  延伸查詢new window
22.阮逸功、陳文夫、佐藤博(1979)。兩側同時性乳癌(病例報告並分析日本的文獻報告)。中華外科誌，12(3)，278-283。  延伸查詢new window
23.Chen, K. T. S.、Chang, K. J.、Chang, Y. Z.、Wang, S. M.、Chen, K. M.(1991)。Factors affecting local or regional recurrence in breast cancer。J Formos Med Assoc，90，986-992。  new window
24.Chie, W. C.、Cheng, K. W.、Fu, C. H.、Yen, L. L.(1992)。A study on women's practice of breast self-examination in Taiwan。Prev Med，22，1-9。  new window
25.Chie, W. C.、Chang, K. J.(1993)。Factors related to tumor size of breast cancer at treatment in Taiwan。Prev Med，23，91-97。  new window
26.Hsu, C. Y.、Shih, T. F.(1988)。Comparative study of X-Ray mammography and xerography of breast cancer in diagnosis of breast tumors -- a preliminary report。Chin J Radiol，13，225-234。  new window
27.Ng, S. H.、Ko, S. F.、Lee, C. M.(1991)。Mammography of breast carcinoma: experience of 108 cases。J Formos Md Assoc，90，541-546。  new window
28.Chen, S. C.、Chen, R. J.、Ng, S. H.、Chen, M. F.(1992)。Ultrasonic and X-Ray mammography in young women with breast lesions。J Surg Assoc ROC，25，963-967。  new window
29.Chou, Y. H.、Tin, C. M.、Lee, S. S.、Chen, C. M.、Chang, T.(1992)。Imaging of breasts in symptomatic patients: a comparison of ultrasonic and X-Ray mammography。Journal of Ultrasound in Medicine of the R.O.C.，9，1-10。  new window
30.王永輝(1988)。乳房腫瘤之非侵襲性影像診斷。台灣醫誌醫學繼續教育，2(3)，417-421。  延伸查詢new window
31.王德錦、楊圳隆、楊東傑(19880500)。隱藏性乳房病灶之定位及其治療。中華民國外科醫學會雜誌，21(3)，340-346。  延伸查詢new window
32.Kou, S. J.、Lui, W. Y.、Su, C. H.(1986)。The value of fine needle aspiration cytology in the diagnosis of the breast disease。J Surg Assoc ROC，19，129-135。  new window
33.Kuo, S. H.、Lin, C. C.、Yu, S. C.、Liaw, K. Y.、Wei, T. C.(1985)。Nuclear DNA content m benign and malignant tumors of the breast--with its diagnostic application on cytologically doubtful aspiration smears of breast lesions。J Formos Med Assoc，84，1117-1125。  new window
34.王永輝(1984)。手術後乳癌之輔助性化學療法。中華民國癌症醫學會會刊，5(2)，1-5。  延伸查詢new window
35.Wang, Y. H.(1987)。Laser surgery for radical mastectomy。Kaohsiung J Med Sciences，3(10)，647-650。  new window
36.Wang, Y. H.(1987)。Laser operation for breast cancer。Int Surg，72，208-210。  new window
37.王永輝(1986)。二氧化碳雷射手術在乳房疾病之使用。中華民國醫用雷射學會會刊，1(2)，15-21。  延伸查詢new window
38.Wang, Y. H.(1988)。Can the laser surgery reduce operation time? In comparison with electric dissection。Bull Laser Med Society ROC，2(2)，12-16。  new window
39.張金堅、陳楷模(19890300)。乳癌之診斷及治療現況。臺灣醫學會雜誌. 繼續教育系列，88(附冊2)，s163-s166。  延伸查詢new window
40.吳坤煥、劉去非(19850900)。乳癌之輔助性治療--化學療法與放射線療法之比較。中華民國外科醫學會雜誌，18(3)，295-299。  延伸查詢new window
41.Yeh, C. Y.、Chung, C. H.、Liu, M. T.(1990)。Radiotherapy for locally recurrent breast cancer。J Formos Med Assoc，89，554-558。  new window
42.Liu, T. J.(1986)。Dynamic hormonal chemotherapy in advanced metastatic breast carcinoma。J Formos Med Assoc，85，376-383。  new window
43.Liu, T. J.、Chi, C. W.、Cheng, E. C.(1981)。Clinical study of estrogen receptor in Chinese patients with breast cancer。J Formos Med Assoc，80，909-918。  new window
44.Chen, T. J.、Chen, K. M.(1987)。Estrogen and progesterone receptors in human breast cancer。J Formos Med Assoc，86，366-372。  new window
45.張玨、黃梅羹、林弘崇(1988)。乳癌病人的壓力與調適初步探討。中華衛誌，8(2)，109-124。  延伸查詢new window
46.Hwan, L. L.、Tsai, M. W.、Lien, I. N.(1987)。The effect of home exercise program on shoulder motions of postmastectomy patients。物理治療學會雜誌，12，83-89。  new window
圖書
1.Department of Health, Executive Yuan(1979)。Cancer Registry Annual Report of Republic of China, 1979-1991。  new window
其他
1.鐘森明，張評迪，施柏安(1991)。炎性乳癌臨床經驗。  延伸查詢new window
2.沈茂昌，許漢銘，蔡志仁(1992)。晩期蕈狀乳癌之動脈內灌注化學治療。  延伸查詢new window
3.余家政，陳啓明，雷永耀，彭芳谷(1988)。乳房Paget式病。  延伸查詢new window
4.徐榮辰，楊圳隆，王德錦(1992)。以腋下淋巴腫塊為表徵之乳癌。  延伸查詢new window
5.王德錦，蔡尚達，陳哲雄(1988)。乳房腺內癌。  延伸查詢new window
6.王德錦，陳炯林，黃共墦(1993)。乳房腺內癌。  延伸查詢new window
7.蔡明哲，廖金水，李伯璋，王文彥，林水龍(1989)。Andenoid cystic carcinoma of the breast。  延伸查詢new window
8.葉大成，黃志仁，楊美都(1991)。乳頭溢液。  延伸查詢new window
9.陳文崇，候明鋒，陳漢文(1990)。乳癌轉移至脈絡膜--病例報告。  延伸查詢new window
10.侯明鋒，邱元亨，陳漢文(1991)。乳癌引起的癌症相關性視網膜病變(CAR症候群)。  延伸查詢new window
11.陳啓明，雷永耀，彭芳谷(1987)。乳癌外科治療的臨床經驗。  延伸查詢new window
12.王德錦(1990)。乳房保存手術對早期乳癌之治療。  延伸查詢new window
13.陳啓明(1992)。早期乳癌之乳房保留手術(台灣醫學會八十一年度地方醫學會專題演講)。  延伸查詢new window
14.張耀台，龍屆泉，劉銘(1991)。乳癌與懷孕。  延伸查詢new window
15.吳介智，吳成中，陳振鵬，吳天成，劉自嘉(1987)。原發性末期乳癌之治療。  延伸查詢new window
16.陳啓明，吳麗華，高莉華(1990)。以流式細胞分析儀來測定國人乳癌的染色體套數。  延伸查詢new window
17.葉顯堂，李威傑，陳楷模(1993)。73件乳癌冷凍切片組織去氧核糖核酸流動細胞計數法及其它預後因子。  延伸查詢new window
18.羅世薰，王會暢，石宜銘，雷永耀(1993)。乳癌之細胞核酸流式計數分析。  延伸查詢new window
19.陳石池，張金堅，周燕輝(1992)。老年女性乳癌。  延伸查詢new window
20.葉顯堂，陳廣天，陳同仁，陳楷模(1993)。乳癌芳香轉換酶的活性。  延伸查詢new window
21.施柏安，尤瑜文，郭守仁，周桂芳，賴銘淙(1991)。乳癌之癌胚抗原。  延伸查詢new window
22.葉俊廷，田郁文，張金堅，陳楷模(1992)。Male Breast cance--18 cases analysis and review of literatures。  延伸查詢new window
23.蔡正中，陳啓明，王惠暢(1993)。男性乳癌。  延伸查詢new window
 
 
 
 
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