臺灣博碩士論文加值系統

研究動機與目的：惡性腫瘤在近年來為國人十大死因之首，而十大癌症死亡率中，乳癌位居第四，也是臺灣女性發生率第一位之癌症。為了提升癌症預防及診治服務之品質，2003年衛生福利部開始實施「癌症諮詢計畫規劃費」，鼓勵醫師以多科團隊照護模式提供病患完整醫療照護。然而，國內至今尚無針對多專科團隊照護對於乳癌病患復發風險之研究，因此本研究欲探討實施多專科團隊照護對乳癌病患復發與存活是否有影響。
方法：本研究屬於回溯性研究，以2004至2010年間新罹患乳癌者為研究對象，將病患以是否納入多專科做為分類，為了降低納入多專科團隊照護之選擇性偏差，以傾向分數(Propensity score matching)進行1：1配對分析，取得有加入與未加入多專科之乳癌病患各9,266人，並利用對數等級檢定(Log-Rank test)分析有無加入多專科團隊照護對於乳癌病患其基本資料、健康情形、經濟因素、環境因素、主要就醫醫療機構特性、主要治療醫師特性、癌症期別、治療方式及是否復發風險之差異比較。利用Cox 比例風險模型(Cox proportional hazards model) 探討多專科團隊照護對於乳癌病患復發風險之影響及相關因素，並利用Kaplan-Meier繪製加入多專科團隊照護與否對於乳癌病患復發機率曲線。
結果：加入多專科團隊之乳癌病患復發比例(2.56%)較未加入者(2.96%)低，且加入多專科團隊照護其復發風險也較未加入者低(HR=0.84，95%CI：0.70-0.99)。投保金額越高、其主要就醫醫師服務量越高、癌症期別越早之乳癌病患其復發風險越小。就存活而言，病患未加入多專科照護之死亡比例(13.05%)高於加入者(12.48%)，病患加入多專科團隊照護之死亡風險顯著低於未加入者(HR=0.89，95%CI：0.82-0.96)。有復發者之死亡風險為無復發者的8.48倍(95%CI：7.53-9.54)。
結論：臺灣有加入多專科照護團隊之乳癌病患其復發風險與死亡風險較未加入多專科團隊照護低，顯示多專科照護團隊之政策可有效提升醫療照護品質，並提高存活率。

Background: Cancer was the top leading cause of death in the past decade in Taiwan. In Taiwan, breast cancer not only was ranked the fourth in the top ten leading causes of death but also was the most common female cancer. To elevate the prevention and service quality of diagnosis and treatment for cancer, the National Health Insurance Administration implemented “Cancer patient treatment planning and consultation (CPTPC) program” in 2003, which prompted physicians to apply multidisciplinary team (MDT) care to provide patients with completing cancer treatments. However, there were few studies on the risk of recurrence of breast cancer patients treated with MDT, and therefore we analyzed the influence of MDT on recurrence and death of breast cancer patients.
Method: In this retrospective study, we sampled newly diagnosed patients suffering from breast cancer from 2004 to 2010, and divided them into two groups based on whether or not they received MDT (multidisciplinary team) care. In order to reduce selection bias in MDT care, patients were analyzed by propensity score, and then were matched with a ratio of 1：1. The study included 9,266 breast cancer patients who were enrolled in multidisciplinary team care and 9,266 breast cancer patients who weren’t enrolled. The study used log-rank test to analyze patients’ characteristics, health status, premium-based monthly salary, urbanization of residence areas, hospital characteristics, physician’s cancer annual service volume, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. The study performed Cox proportional hazards model to examine influence of MDT and associated factors with recurrence of the breast cancer patients.
Results: The recurrence rates (2.56%) of breast cancer patients who were enrolled in MDT care were lower than that of patients who weren’t enrolled (2.96%). Relative risk of recurrence was also lower for patients with MDT care than that of patients without MDT care (HR=0.84; 95%CI: 0.70 to 0.99). People with higher premium-based monthly salary, higher physician’s cancer annual service volume, or early cancer staging had lower risk of recurrence. In terms of death, the death rate (13.05%) of breast cancer patients who weren’t enrolled in MDT care was higher than that of patients who were enrolled (12.48%). The risk of death was lower for patients with MDT care than that of patients without MDT care (HR=0.89; 95%CI: 0.82 to 0.96). The death risk for breast cancer patients who had relapsed was 8.48 times (95%CI: 7.53 to 9.54) that of patients without relapsed.
Conclusions: The relative risk of recurrence and death was lower for breast cancer patients who were enrolled in multidisciplinary team care in Taiwan. It shows that MDT care not only increases the quality of health care services, but also increases the survival rate.

目錄
摘要 I
Abstract III
致謝 V
目錄 VI
表目錄 VII
圖目錄 VIII
第一章 緒 論 1
第一節、研究背景與動機 1
第二節、研究目的 3
第二章 文獻探討 4
第一節、乳癌之流行病學 4
第二節、乳癌之治療方式 6
第三節、癌症多專科團隊照護 9
第四節、乳癌的危險因子及影響復發風險之相關因素 11
第五節、影響乳癌病患存活及相關因素 13
第六節、文獻小結 15
第三章 研究設計與方法 16
第一節、研究架構 16
第二節、研究假設 19
第三節、研究對象 20
第四節、資料來源 22
第五節、研究變項說明與操作型定義 24
第六節、統計分析方法 30
第四章 結果 32
第五章 討論 37
第一節、多專科團隊照護對乳癌病患復發風險之差異 37
第二節、影響乳癌病患復發風險之相關因素 39
第三節、多專科團隊照護及復發對乳癌病患死亡風險之影響及相關因素 41
第六章 結論與建議 43
參考文獻 61
附錄一 都市化程度分級表 68

Atun, R., Ogawa, T., & Martin-Moreno, J. M. (2009). Analysis of national cancer control programmes in Europe. London： Imperial College London Business School.
Albain, K. S., Allred, D. C., & Clark, G. M. (1993). Breast cancer outcome and predictors of outcome: are there age differentials? Journal of the National Cancer Institute. Monographs(16), 35-42.
Birchall, M., Bailey, D., & King, P. (2004). Effect of process standards on survival of patients with head and neck cancer in the south and west of England. British Journal of cancer, 91(8), 1477-1481. Retrieved from http：//www.ncbi.nlm.nih.gov/pmc/articles/PMC2409928/pdf/91-6602118a.pdf
Bowcock, A., Anderson, L., Friedman, L., Black, D., Osborne-Lawrence, S., Rowell, S., . . . King, M.-C. (1993). THRA1 and D17S183 flank an interval of< 4 cM for the breast-ovarian cancer gene (BRCA1) on chromosome 17q21. American journal of human genetics, 52(4), 718.
Calman, K. C., & Hine, D. (1995). A policy framework for commissioning cancer services. A report by the expert advisory group on cancer to the chief medical officers of England and Wales： guidance for purchasers and providers of cancer services： Department of Health.
Chang, J. H., Vines, E., Bertsch, H., Fraker, D. L., Czerniecki, B. J., Rosato, E. F., . . . Schuchter, L. (2001). The impact of a multidisciplinary breast cancer center on recommendations for patient management. Cancer, 91(7), 1231-1237.
Chaudhry, R., Goel, V., & Sawka, C. (2001). Breast cancer survival by teaching status of the initial treating hospital. Canadian Medical Association Journal, 164(2), 183-188.
Chlebowski, R. T., Blackburn, G. L., Thomson, C. A., Nixon, D. W., Shapiro, A., Hoy, M. K., . . . McAndrew, P. (2006). Dietary fat reduction and breast cancer outcome： interim efficacy results from the Women''s Intervention Nutrition Study. Journal of the National Cancer Institute, 98(24), 1767-1776.
Cossetti, R. J., Tyldesley, S. K., Speers, C. H., Zheng, Y., & Gelmon, K. A. (2014). Comparison of breast cancer recurrence and outcome patterns between patients treated from 1986 to 1992 and from 2004 to 2008. Journal of Clinical Oncology, JCO. 2014.2057. 2461.
Crosswhite, R., Beckham, S. H., Gray, P., Hawkins, P. R., & Hughes, J. (1997). Using a multidisciplinary automated discharge summary process to improve information management across the system. The American journal of managed care, 3(3), 473-479.
Dalton, S. O., Ross, L., Düring, M., Carlsen, K., Mortensen, P. B., Lynch, J., & Johansen, C. (2007). Influence of socioeconomic factors on survival after breast cancer—a nationwide cohort study of women diagnosed with breast cancer in Denmark 1983–1999. International journal of cancer, 121(11), 2524-2531.
DeSantis, C. E., Bray, F., Ferlay, J., Lortet-Tieulent, J., Anderson, B. O., & Jemal, A. (2015). International variation in female breast cancer incidence and mortality rates. Cancer Epidemiology Biomarkers & Prevention, 24(10), 1495-1506.
DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: a cancer journal for clinicians, 64(1), 52-62.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of clinical epidemiology, 45(6), 613-619.
Early Breast Cancer Trialists'' Collaborative Group. (2006). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival： an overview of the randomised trials. The Lancet, 366(9503), 2087-2106.
Easton, D. F., Ford, D., & Bishop, D. T. (1995). Breast and ovarian cancer incidence in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. American journal of human genetics, 56(1), 265.
Fleissig, A., Jenkins, V., Catt, S., & Fallowfield, L. (2006). Multidisciplinary teams in cancer care： are they effective in the UK? The Lancet Oncology, 7(11), 935-943.
Forrest, L., McMillan, D., McArdle, C., & Dunlop, D. (2005). An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer. British Journal of cancer, 93(9), 977-978.
Frederick, L., Page, D. L., Fleming, I. D., Fritz, A. G., Balch, C. M., Haller, D. G., & Morrow, M. (2002). AJCC cancer staging manual (Vol. 1)： Springer Science & Business Media.
Gironés, R., Torregrosa, D., & Díaz-Beveridge, R. (2010). Comorbidity, disability and geriatric syndromes in elderly breast cancer survivors. Results of a single-center experience. Critical reviews in oncology/hematology, 73(3), 236-245.
Golledge, J., Wiggins, J., & Callam, M. (2000). Effect of surgical subspecialization on breast cancer outcome. British journal of surgery, 87(10), 1420-1425.
Group, E. B. C. T. C. (2015). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. The Lancet, 386(10001), 1341-1352.
Greene, F. L. (2002). AJCC cancer staging manual (Vol. 1)： Springer Science & Business Media.
Guha, N., Kwan, M. L., Quesenberry Jr, C. P., Weltzien, E. K., Castillo, A. L., & Caan, B. J. (2009). Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors： the Life After Cancer Epidemiology study. Breast cancer research and treatment, 118(2), 395-405.
Houssami, N., & Sainsbury, R. (2006). Breast cancer： multidisciplinary care and clinical outcomes. European Journal of Cancer, 42(15), 2480-2491.
Hsieh, C. C., Trichopoulos, D., Katsouyanni, K., & Yuasa, S. (1990). Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: Associations and interactions in an international case‐control study. International journal of cancer, 46(5), 796-800.
Ingram, D., McEvoy, S., Byrne, M., Fritschi, L., Joseph, D., & Jamrozik, K. (2005). Surgical caseload and outcomes for women with invasive breast cancer treated in Western Australia. The Breast, 14(1), 11-17.
Junor, E., Hole, D., & Gillis, C. (1994). Management of ovarian cancer： referral to a multidisciplinary team matters. British Journal of cancer, 70(2), 363.
Katterhagen, J., & Wishart, D. (1977). The tumor board—How it works in a community hospital. CA： a cancer journal for clinicians, 27(4), 201-204.
Kerstetter, N. C. (1990). A stepwise approach to developing and maintaining an oncology multidisciplinary conference. Cancer nursing, 13(4), 216-220.
Kesson, E. M., Allardice, G. M., George, W. D., Burns, H. J., & Morrison, D. S. (2012). Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. bmj, 344, e2718.
Kung, P.-T., & Tsai, W.-C. (2014). P0213 Effects of multidisciplinary care on survival of breast cancer： Results from a national cohort study. European Journal of Cancer, 50, e69.
Land, L. H., Dalton, S. O., J??rgensen, T. L., & Ewertz, M. (2012). Comorbidity and survival after early breast cancer. A review. Critical reviews in oncology/hematology, 81(2), 196-205.
Lauby-Secretan, B., Scoccianti, C., Loomis, D., Benbrahim-Tallaa, L., Bouvard, V., Bianchini, F., & Straif, K. (2015). Breast-cancer screening—viewpoint of the IARC Working Group. New England Journal of Medicine, 372(24), 2353-2358.
Lee, S. M., Park, J. H., & Park, H. J. (2008). Breast cancer risk factors in Korean women： a literature review. International nursing review, 55(3), 355-359.
Levine, R. A., Chawla, B., Bergeron, S., & Wasvary, H. (2012). Multidisciplinary management of colorectal cancer enhances access to multimodal therapy and compliance with National Comprehensive Cancer Network (NCCN) guidelines. International journal of colorectal disease, 27(11), 1531-1538.
Li, C. I., Malone, K. E., & Daling, J. R. (2003). Differences in breast cancer stage, treatment, and survival by race and ethnicity. Archives of internal medicine, 163(1), 49-56.
Luft, H. S., Hunt, S. S., & Maerki, S. C. (1987). The volume-outcome relationship： practice-makes-perfect or selective-referral patterns? Health services research, 22(2), 157.
McGale, P., Taylor, C., Correa, C., Cutter, D., Duane, F., Ewertz, M., . . . Whelan, T. (2014). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality：meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet (London, England), 383(9935), 2127-2135.
McPherson, K., Steel, C., & Dixon, J. (2000). Breast cancer-epidemiology, risk factors, and genetics. BMJ: British Medical Journal, 321(7261), 624.
Mikeljevic, J. S., Haward, R., Johnston, C., Sainsbury, R., & Forman, D. (2003). Surgeon workload and survival from breast cancer. British journal of cancer, 89(3), 487-491.
Nagata, C., Hu, Y. H., & Shimizu, H. (1995). Effects of Menstrual and Reproductive Factors on the Risk of Breast Cancer: Meta‐analysis of the Case‐Control Studies in Japan. Japanese Journal of Cancer Research, 86(10), 910-915.
Ng, W. T., Lee, M. C., Hung, W. M., Choi, C. W., Lee, K. C., Chan, O. S., & Lee, A. W. (2011). Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. International Journal of Radiation Oncology* Biology* Physics, 79(2), 420-428.
Nigro, N. D. (1987). Multidisciplinary management of cancer of the anus. World journal of surgery, 11(4), 446-451.
Nixon, A. J., Neuberg, D., Hayes, D. F., Gelman, R., Connolly, J. L., Schnitt, S., . . . Harris, J. R. (1994). Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. Journal of Clinical Oncology, 12(5), 888-894.
Odijk, J. v., Kull, I., Borres, M., Brandtzaeg, P., Edberg, U., Hanson, L., . . . Skerfving, S. (2003). Breastfeeding and allergic disease： a multidisciplinary review of the literature (1966–2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy, 58(9), 833-843.
Penson, R. T., Kyriakou, H., Zuckerman, D., Chabner, B. A., & Lynch, T. J. (2006). Teams： communication in multidisciplinary care. The Oncologist, 11(5), 520-526.
Piccirillo, J. F. (2000). Importance of comorbidity in head and neck cancer. The Laryngoscope, 110(4), 593-602.
Piccirillo, J. F., Sasaki, C. T., Wells, C. K., & Feinstein, A. R. (1994). New Clinical Severity Staging System for Cancer of the Larynx Five-Year Survival Rates. Annals of Otology, Rhinology & Laryngology, 103(2), 83-92.
Purushotham, A., Pain, S., Miles, D., & Harnett, A. (2001). Variations in treatment and survival in breast cancer. The Lancet Oncology, 2(12), 719-725.
Revenig, L. M., Canter, D. J., Taylor, M. D., Tai, C., Sweeney, J. F., Sarmiento, J. M., . . . Ogan, K. (2013). Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. Journal of the American College of Surgeons, 217(4), 665-670. e661.
Rezaianzadeh, A., Peacock, J., Reidpath, D., Talei, A., Hosseini, S. V., & Mehrabani, D. (2009). Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran. BMC cancer, 9(1), 168.
Richardson, B., Preskitt, J., Lichliter, W., Peschka, S., Carmack, S., de Prisco, G., & Fleshman, J. (2016). The effect of multidisciplinary teams for rectal cancer on delivery of care and patient outcome: has the use of multidisciplinary teams for rectal cancer affected the utilization of available resources, proportion of patients meeting the standard of care, and does this translate into changes in patient outcome? The American Journal of Surgery, 211(1), 46-52.
Rock, C. L., Byers, T. E., Colditz, G. A., Demark-Wahnefried, W., Ganz, P. A., Wolin, K. Y., . . . Naughton, M. (2013). Reducing breast cancer recurrence with weight loss, a vanguard trial： the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial. Contemporary clinical trials, 34(2), 282-295.
Sainsbury, R., Haward, R., Round, C., Rider, L., & Johnston, C. (1995). Influence of clinician workload and patterns of treatment on survival from breast cancer. The Lancet, 345(8960), 1265-1270.
Sant, M., Allemani, C., Capocaccia, R., Hakulinen, T., Aareleid, T., Coebergh, J. W., . . . Bell, J. (2003). Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe. International journal of cancer, 106(3), 416-422.
Saphner, T., Tormey, D. C., & Gray, R. (1996). Annual hazard rates of recurrence for breast cancer after primary therapy. Journal of Clinical Oncology, 14(10), 2738-2746.
Schmidt, M. E., Chang‐Claude, J., Vrieling, A., Seibold, P., Heinz, J., Obi, N., . . . Steindorf, K. (2013). Association of pre‐diagnosis physical activity with recurrence and mortality among women with breast cancer. International Journal of Cancer, 133(6), 1431-1440.
Schnitt, S. J., Connolly, J. L., Harris, J. R., Hellman, S., & Cohen, R. B. (1984). Pathologic predictors of early local recurrence in stage I and II breast cancer treated by primary radiation therapy. Cancer, 53(5), 1049-1057.
Serrano-Fabiá, A., Albert-Marí, A., Almenar-Cubells, D., & Jiménez-Torres, N. V. (2010). Multidisciplinary system for detecting medication errors in antineoplastic chemotherapy. Journal of Oncology Pharmacy Practice, 16(2), 105-112.
Shariff-Marco, S., Yang, J., John, E. M., Sangaramoorthy, M., Hertz, A., Koo, J., . . . Cockburn, M. (2014). Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study. Cancer Epidemiology and Prevention Biomarkers.
Siegel, R., Ma, J., Zou, Z., & Jemal, A. (2014). Cancer statistics, 2014. CA： a cancer journal for clinicians, 64(1), 9-29.
Siegel, R. L., Miller, K. D., & Jemal, A. (2015). Cancer statistics, 2015. CA： a cancer journal for clinicians, 65(1), 5-29.
Simcock, R., & Heaford, A. (2012). Costs of multidisciplinary teams in cancer are small in relation to benefits. BMJ, 344, e3700.
Skandarajah, A. R., & Mann, G. B. (2013). Selective use of whole breast radiotherapy after breast conserving surgery for invasive breast cancer and DCIS. The Surgeon, 11(5), 278-285.
Sopik, V., Nofech-Mozes, S., Sun, P., & Narod, S. A. (2015). The relationship between local recurrence and death in early-stage breast cancer. Breast cancer research and treatment, 1-11.
Spilsbury, K., Semmens, J. B., Saunders, C. M., & Holman, C. (2005). Long‐term survival outcomes following breast cancer surgery in Western Australia. ANZ journal of surgery, 75(8), 625-630.
Sprague, B. L., Trentham‐Dietz, A., Gangnon, R. E., Ramchandani, R., Hampton, J. M., Robert, S. A., . . . Newcomb, P. A. (2011). Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer, 117(7), 1542-1551.
Stitzenberg, K. B., & Meropol, N. J. (2010). Trends in centralization of cancer surgery. Annals of surgical oncology, 17(11), 2824-2831.
Swain, S. M., Baselga, J., Kim, S.-B., Ro, J., Semiglazov, V., Campone, M., . . . Heeson, S. (2015). Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. New England Journal of Medicine, 372(8), 724-734.
Taylor, C., Munro, A. J., Glynne-Jones, R., Griffith, C., Trevatt, P., Richards, M., & Ramirez, A. J. (2010). Multidisciplinary team working in cancer： what is the evidence? BMJ, 340.
Taylor, C., Shewbridge, A., Harris, J., & Green, J. S. (2013). Benefits of multidisciplinary teamwork in the management of breast cancer. Breast Cancer： Targets and Therapy, 5, 79.
Thull, D. L., & Vogel, V. G. (2004). Recognition and management of hereditary breast cancer syndromes. The Oncologist, 9(1), 13-24.
Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet‐Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012. CA： a cancer journal for clinicians, 65(2), 87-108.
Tripathy, D. (2003). Multidisciplinary care for breast cancer: barriers and solutions. The breast journal, 9(1), 60-63.
Tsai, W.-C., Kung, P.-T., Wang, S.-T., Huang, K.-H., & Liu, S.-A. (2015). Beneficial impact of multidisciplinary team management on the survival in different stages of oral cavity cancer patients： Results of a nationwide cohort study in Taiwan. Oral oncology, 51(2), 105-111.
Wooster, R., Neuhausen, S. L., Mangion, J., Quirk, Y., Ford, D., Collins, N., . . . Averill, D. (1994). Localization of a breast cancer susceptibility gene, BRCA2, to chromosome 13q12-13. Science, 265(5181), 2088-2090.
Wu, I.-W., Wang, S.-Y., Hsu, K.-H., Lee, C.-C., Sun, C.-Y., Tsai, C.-J., & Wu, M.-S. (2009). Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality—a controlled cohort study based on the NKF/DOQI guidelines. Nephrology Dialysis Transplantation, gfp259.
Ye, Y., Shen, Z., Sun, X., Wang, Z., Shen, D., Liu, H., . . . Poston, G. (2012). Impact of multidisciplinary team working on the management of colorectal cancer. Chinese medical journal, 125(2), 172-177.
Zorbas, H., Barraclough, B., Rainbird, K., Luxford, K., & Redman, S. (2003). Multidisciplinary care for women with early breast cancer in the Australian context： what does it mean? Medical Journal of Australia, 179(10), 528-531.
林建宏. (2014). 標靶藥物用於 HER2 陽性乳癌治療之探討. 彰基藥訊, 22(2), 5-8.
侯明鋒, 陳芳銘, & 歐陽賦. (2008). 乳癌手術的沿革. 中華民國癌症醫學會雜誌, 24(2), 102-107.
莊岳泉, & 趙祖怡. (2008). 乳癌的輔助性化療. 中華民國癌症醫學會雜誌, 24(2), 112-120.
陳育瑄, & 郭頌鑫. (2013). 乳癌的放射治療. 臺灣醫學, 17(4), 390-396.
許維中, 廖宏恩, 鍾娜娜, 王博民, & 詹淑卿. (2013). 癌症多專科團隊會議運作模式與未來展望. 放射治療與腫瘤學, 20(2), 127-134.
黃俊升. (2013). 乳癌治療新進展. 臺灣醫學, 17(4), 381-382.
范淑貞. (2016). 多專科團隊管理介入對口癌病患復發風險之影響. 中國醫藥大學醫務管理學系碩士在職專班學位論文, 1-77.
郭文宏, & 張金堅. (2006). 乳癌. 臺灣醫學, 10(4), 475-481.
黃素馨. (2013). 乳癌手術病人術後 5 年死亡預測模式之探討. 高雄醫學大學醫學研究所學位論文, 1-96.
張景明, & 張金堅. (2016). 肥胖與癌症. 中華民國內膜異位症婦女協會會刊, 23(3&4), 10-14.
劉介宇, 洪永泰, 莊義利, 陳怡如, 翁文舜, 劉季鑫, & 梁賡義. (2006). 台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究. 健康管理學刊, 4(1), 1-22.
蔡宛臻. (2011). 癌症多專科診療團隊對乳癌病患存活之影響. 中國醫藥大學醫務管理學系碩士班學位論文, 1-59.
謝德熾, & 陳立奇. (2010). 乳癌治療之演進. 北市醫學雜誌, 7(3), 313-322.
鄭麗菁, & 解剖學. (2008). 醫用解剖學： Elsevier Health Sciences TW.
【參考網站】
AJCC. (2014). American Joint Committee on Cancer Staging Manual. Retrieved from https：//cancerstaging.org/Pages/default.aspx
IARC. (2015). Retrieved from http：//www.iarc.fr/
Organization, W. H. (2015). Retrieved from http：//www.who.int/en/
SEER. (2015). Surveillance Epidemiology and End Results. Retrieved from http：//seer.cancer.gov/
WHO. (2016). World Health Organization. Retrieved from http：//www.who.int/en/
國家衛生研究院. (2017). National Health Research Institutes. Retrieved from http：//www.nhri.org.tw/NHRI_WEB/nhriw001Action.do
衛生福利部. (2015a). 104年度癌症診療品質認證 癌症診療品質認證基準及評分說明。. Retrieved from http：//www.mohw.gov.tw/cht/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=5311&doc_no=48963
衛生福利部統計處. (2016). 2014年國人死因統計結果. Retrieved from http：//www.mohw.gov.tw/CHT/DOS/DM1_P.aspx?f_list_no=557&fod_list_no=366&doc_no=51078