Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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Current opinion for breast cancer screening

유방암 선별검사의 최신 지견

Lee, Chae-Hyeong;Roh, Ju-Won
이채형;노주원

  • Published : 20080900
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Abstract

Breast cancer has become one of the most significant health concerns not only in western countries but also in Korea. Screening is the most important method to reduce the mortality related to breast cancer. However, controversy remains about some aspects of breast cancer screening. Breast self-examination has been shown not to improve cancer-specific mortality, but it is commonly advocated as a noninvasive screen. Although the contribution of the clinical breast examination to early detection is difficult to determine, up to 10 percent of mammographically silent cancers can be detected by clinical breast examination. Major health organizations endorse mammographic screening every one to two years for women 40 years, and every year after age 50 as long as the woman is healthy. Although breast magnetic resonance imaging shows promise as a screening tool in high-risk women 30 years and older, it is not currently recommended for general screening because of high false-positive rates and costs. When applying guidelines to individual patients, risk assessment and clinical judgment including physical examination is needed to ensure appropriate management.

유방암은 서구의 여성뿐만 아니라 한국여성에 있어서도 이제는 여성건강에 있어서 가장 중요한 문제로 부각되고 있는 질환이 다. 유방암으로 인한 사망률을 감소시키기 위해서는 효과적인 선별검사를 시행하는 것이 가장 중요한 일이다. 그러나 기존의 유방암 선별검사에 대해서는 여전히 논란의 여지가 존재한다. 유방자가검사는 유방암으로 인한 사망률 감소에 대한 효과가 불확실하나, 비침습적이고 비용이 들지 않아 여전히 추천되고 있으며, 유방 질환에 대한 관심을 높이는 효과도 기대할 수 있다. 임상유방검사의 효용성에 대해서도 아직 논란의 여지가 있으나, 약 5~10%의 유방암 환자가 유방조영술에서는 정상이 면서 임상유방검사에 의하여 처음으로 진단되는 경우가 있어 추천되고 있는 검사법이다. 유방암 선별검사의 가장 대표적인 검사법인 유방조영술은 40대의 여성에서는 1~2년 간격으로, 50대 이상에서는 매년 시행하는 것이 추천되고 있다. 최근에는 고위험 여성에서 유방자기공명영상의 민감도가 기존의 영상에 비하여 현저히 높다는 보고가 있어, 30세 이상의 고위험 여성 에서 선별검사법으로 고려할 수 있으나, 높은 위양성도와 비용으로 인하여 평균적 위험도를 가진 여성에서는 추천되지 않는 다. 유방암 선별검사를 환자에게 적용할 때에는 각각의 환자에 대한 유방암 발생 위험도 평가와 이학적 검사를 포함한 임상 적 판단이 적절한 처치를 위해서는 무엇보다도 중요한 요소임을 명심해야 한다.

Keywords

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