臨床婦科醫(yī)學(xué)英語翻譯:乳腺癌(1)

Breast Cancer

乳腺癌

Breast cancer most often involves glandular breast cells in the ducts or lobules. Most patients present with an asymptomatic lump discovered during examination or screening mammography. Diagnosis is confirmed by biopsy. Treatment usually includes surgical excision, often with radiation therapy and adjuvant systemic therapy.

乳腺癌大多累及乳腺管或小葉乳腺細(xì)胞，多數(shù)病人在檢查或乳房X線照相時發(fā)現(xiàn)一無癥狀腫塊，通過組織活檢確診。治療通常包括外科切除，常伴以放療和輔助性全身療法。

About 203,000 new cases were identified in 2003. It is the 2nd leading cause of cancer death in women (after lung cancer), with about 40,000 deaths in 2003. Male breast cancer accounts for < 1% of total cases; manifestations, diagnosis, and management are the same, although men tend to present later.

2003年確認(rèn)的新病例有203,000例，它是導(dǎo)致婦女因癌癥死亡的第二大原因（僅次于肺癌)，其中有40,000例就死于2003年。男性乳腺癌在全部病例中所占的比例不到1%。雖然男性癥狀往往出現(xiàn)較晚，但其臨床表現(xiàn)、診斷與處理與女性相同。

Risk Factors

危險因素

In the US, cumulative risk of developing breast cancer is 12% (1 in 8) by age 95, and risk of dying of it is about 4%. Much of the risk is incurred after age 60 (see Table 1: Breast Disorders: Breast Cancer Risks). These statistics can be misleading because cumulative risk of developing the cancer in any 20-yr period is considerably lower.

在美國，95歲時患乳腺癌的累積危險率是12%（8個有1個)，死亡危險率約4%。危險多數(shù)發(fā)生在60歲以后（見表1：乳房疾�。喝橄侔┑奈ｋU性)。這些統(tǒng)計數(shù)字可能使人誤解，因為在任一20年期內(nèi)，乳腺癌的累積危險性都要低得多。

Family history of breast cancer in a 1st-degree relative (mother, sister, daughter) doubles or triples risk of developing the cancer, but history in more distant relatives increases risk only slightly. When ≥ 2 1st-degree relatives have breast cancer, risk may be 5 to 6 times higher. About 5% of women with breast cancer carry a mutation in one of the 2 known breast cancer genes, BRCA1 or BRCA2. If relatives of such a woman also carry the gene, they have a 50 to 85% lifetime risk of developing breast cancer. Women with BRCA1 mutations also have a 20 to 40% lifetime risk of developing ovarian cancer; risk among women with BRCA2 mutations is increased less. Women without a family history of breast cancer in at least 2 1st-degree relatives are unlikely to carry this gene and thus do not require screening for BRCA1 and BRCA2 mutations. Men who carry a BRCA2 mutation also have an increased risk of developing breast cancer. The genes are more common among Ashkenazi Jews.

1級親屬（母親、姐妹、女兒)若有乳腺癌家族史，則可使癌癥危險增加2－3倍，但遠(yuǎn)親乳腺癌史對癌癥率影響甚微。當(dāng)≥2個1級親屬有乳腺癌時，危險性可高出5－6倍。約5%的乳腺癌婦女可攜帶2個已知乳腺癌基因（BRCA1或BRCA2)中的一個，如果這些婦女的親屬也攜帶該基因，其患乳腺癌的危險率就可達(dá)到50－80%。BRCA1基因變異婦女一生中得卵巢癌的危險率為20－40%，BRCA2基因變異婦女的危險率增加較少。無乳腺癌家族史（至少有兩個1級親屬沒有)婦女不可能攜帶該基因，因此，也不需要作BRCA1和BRCA2篩查。男性BRCA2攜帶者的乳腺癌危險性也會增加。這些基因在北歐猶太教徒中更為常見。醫(yī)學(xué)全.在線提供

History of in situ or invasive breast cancer increases risk: Risk of developing cancer in the contralateral breast after mastectomy is about 0.5 to 1%/yr of follow-up.醫(yī)學(xué)全在.線gydjdsj.org.cn

原位或浸潤性乳腺癌史增加癌癥危險。乳房切除后，隨訪病人中對側(cè)乳房的癌癥危險率約0.5-1%/年。

Early menarche, late menopause, or late 1st pregnancy increases risk. Women who have a 1st pregnancy after age 30 are at higher risk than those who are nulliparous.

初潮早，停經(jīng)晚，或首次妊娠晚，均可增加癌癥危險。30歲后懷第一胎的婦女，其危險性要高于未產(chǎn)婦。

History of fibrocystic changes requiring biopsy for diagnosis increases risk slightly. Women with multiple breast lumps but no histologic confirmation of a high-risk pattern should not be considered at high risk. Benign lesions that may slightly increase risk of developing invasive breast cancer include complex fibroadenoma, moderate or florid hyperplasia (with or without atypia), sclerosing adenosis, and papilloma. Atypical ductal or lobular hyperplasia increases risk of breast cancer 4- to 5-fold; risk increases to about 10-fold in patients who also have a family history of invasive breast cancer in a 1st-degree relative.

因纖維囊性病變而作活檢診斷，有些病史者的危險性略有增加。有多個乳房腫塊，但無高危型的組織學(xué)確認(rèn)，不應(yīng)視為高危性。有些良性病損可增加得浸潤性乳腺癌危險，這些病損包括復(fù)合纖維腺瘤、中度或鮮紅樣增生（伴或無異型)、硬化性腺病和乳頭狀瘤。非典型性乳腺管或小葉增生使乳腺癌危險增加4－5倍，1級親屬有浸潤性乳腺癌家族史的病人，其危險性可增加約10倍。

Oral contraceptive use increases risk very slightly (by about 5 more cases per 100,000 women). Risk increases primarily during the years of contraceptive use and tapers off during the 10 yr after stopping. Risk is highest in women who began to use contraceptives before age 20 (although absolute risk is still very low).

口服避孕藥者危險性增加很少（每100,000位婦女只增加約5例)。危險性增加主要是在服藥期間，在停藥后10年間逐漸減少。20歲前開始服用避孕藥婦女的得癌危險性最高（盡管其絕對危險率仍然很低)。

Postmenopausal hormone (estrogen plus a progestin) therapy appears to increase risk modestly after only 3 yr of use. With prolonged use, risk is increased by about 7 or 8 cases per 10,000 women for each year of use. Use of estrogen alone does not appear to increase risk of breast cancer. Selective estrogen-receptor modulators (eg, raloxifene) may reduce risk of developing breast cancer.

實施絕經(jīng)后激素（雌激素＋黃體激素)療法3年后，危險性稍有增加。延長使用時，每年每10,000名婦女可增加7-8例。只用雌激素似乎不會增加危險。選擇性雌激素受體調(diào)節(jié)物（如雷洛昔芬)可減少患癌危險。

Diet may play a role in causing or promoting growth of breast cancers, but conclusive evidence about the effect of a particular diet (eg, one high in fats) is lacking. Obese postmenopausal women are at increased risk, but there is no evidence that dietary modification decreases risk. For obese women who are still menstruating, risk may be decreased.

飲食在引起或促進(jìn)乳腺癌生長中起一定作用，但尚無某一特定飲食（如高脂肪飲食)所起作用的結(jié)論性證據(jù)。絕經(jīng)后肥胖婦女危險性增加，但沒有證據(jù)證明改變飲食會降低危險。仍有月經(jīng)來潮的肥胖婦女，危險可能減少。

Exposure to radiation therapy before age 30 increases risk. Mantle-field radiation therapy for Hodgkin lymphoma quadruples risk of breast cancer over the next 20 to 30 yr.

30歲前接受放療增加危險。治療霍杰金淋巴瘤所用的斗篷射野放療可使其未來20－30年間的乳腺癌危險性增加4倍。