乳房攝影篩檢推廣成效之探討

The promotion of mammography screening program

乳癌是全球婦女最主要的癌症之一，在台灣，乳癌為女性癌症發生原因之第一 位，死亡原因之第四位。乳癌雖然對於婦女之健康是極大威脅，但早期發現、早期治 療有絕對較佳的治療效果。為達到「 年內癌症死亡率下降1%」之衛生政策，國健局 自2010年起提供45~69歲及40歲以上二等親有乳癌病史之婦女，每兩年一次免費乳房 攝影檢查，本院亦配合政策大力推動。本研究目的為探討（1）本院乳房攝影篩檢（乳 篩）人數、篩檢率、篩檢目標達成率之成效；（2）乳房攝影篩檢影像之品質；（3） 乳癌確診結果；（4）本院推動乳篩的策略及成功因素。結果：2010年本院乳房攝影篩 檢共6,455人，篩檢率為31.6%，篩檢目標達成率為65.9%，皆達到國健局之目標值。乳 攝影像品質標準PPV1 5.96%、PPV2 34.48%、PPV3 39.47%、乳癌偵測率3.65%、早期乳 癌偵測率43.33%、腋下淋巴結陰性率78.57%、Recall rate 9.53%，皆符合ACR標準。確 診個案且於本院接受治療者共31例，乳癌確診率為4.9‰（33/6787）。乳房攝影篩檢 醫收共8,036,475元，本院之乳篩不僅達成國健局所設之目標，且在全國醫學中心中亦 屬於較佳者。本院運用多重策略，配合政府大力宣傳，使得乳房攝影篩檢推廣成效顯 著。

Breast cancer is one of the major female cancers in global health. It is also the most common female cancer in Taiwan, and the fourth cause of death in female cancer. Although breast cancer is a significant threat to women’s health, early detection and prompt treatment reveals positive prognostic effect. To meet the objective of reducing cancer mortality rate by 10% in 4 years, Department of Health, Executive Yuan of Taiwan launched free mammography screening program in every other year for ladies of all 45 to 69 years old and ladies above 40 years old with family history of breast cancer. The purpose of this study was to investigate (a) the volume of mammography screening, screening rate, screening target achieve rate of our hospital; (b) the image performance quality of mammography; (c) the definite diagnosed outcome; (d) the strategies of promoting mammography screening. Results: In 2010, 6,455 women was screened by mammography in our hospital, the screening rate was 31.6%, screening target achieve rate was 65 .9%. The image performance quality of mammography were as follows: PPV1 5.96 %, PPV2 34.48 %, PPV3 39.47 %, mean breast cancer detection rate was 3.65 %, mean breast cancer early detection rate was 43.33%, Axillary lymph node negative rate was 78 .57 %, Recall rate was 9.53%. There are 31 patients with definite diagnosis of breast cancer who were treated in our hospital. The definite diagnosed rate was 4.9‰. The total revenue from this mammography screening program was 8,036,475 NTD which is beyond the national average of medical centers. The success factors in our mammography screening program include multiple promotion campaigns, participation of all staffs, strong leadership and cooperation with neighboring health facilities.