Universal cancer screening: revolutionary, rational, and realizable
Universal cancer screening: revolutionary, rational, and realizable
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DOI：
10.1038/s41698-018-0066-x
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发表时间：
2018-10-29
影响因子：
7.9
通讯作者：
Ahlquist, David A.
中科院分区：
文献类型：
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作者：
Ahlquist, David A.
癌症仍然是全球第二大死亡原因，总体癌症相关死亡人数正在增加。尽管早期发现对生存有好处，但迄今为止，筛查只针对那些携带足够流行的肿瘤的少数器官，以显示在人群水平上的成本效益，而大多数癌症类型未被筛查。在这一观点概述中，提出了一个普遍癌症筛查的案例，作为一种逻辑和更具包容性的方法，具有潜在的高影响力。生物学和流行病学是普遍筛查的核心重要概念驱动力。肿瘤标志物释放到常见的远距离介质（如血液）中的共享生物学特性可以用于从单一测试中检测多种癌症。而且，通过汇总患病率，普遍筛查允许将所有癌症（包括不太常见的癌症）作为目标，提高筛查效率和肿瘤类型的整合，并可能提高单器官方法的成本效益。新的肿瘤标志物类别的鉴定具有跨肿瘤类型的广泛表达和位点预测，测定技术的显着进步以及引人注目的早期临床数据增加了实现这种新范式的可能性。多器官筛查可以通过靶向循环内或源于循环（包括血液、尿液、唾液和呼气）或脱落到常见排泄途径（包括胃肠道和女性生殖道）的标记物来实现。为了将这一崇高的愿景应用于人群，需要在预期用途人群中进行严格的临床研究，并需要学术界、工业界、专业协会和政府之间的合作。
Cancer remains the second leading cause of mortality worldwide, and overall cancer-related deaths are increasing. Despite the survival benefit from early detection, screening has to date targeted only those few organs that harbor tumors of sufficient prevalence to show cost-effectiveness at population levels, leaving most cancer types unscreened. In this perspective overview, a case is made for universal cancer screening as a logical and more inclusive approach with potentially high impact. The centrally important conceptual drivers to universal screening are biological and epidemiological. The shared biology of tumor marker release into a common distant medium, like blood, can be exploited for multi-cancer detection from a single test. And, by aggregating prevalence rates, universal screening allows all cancers (including less common ones) to be included as targets, increases screening efficiency and integration across tumor types, and potentially improves cost-effectiveness over single-organ approaches. The identification of new tumor marker classes with both broad expression across tumor types and site-prediction, remarkable advances in assay technologies, and compelling early clinical data increase the likelihood of actualizing this new paradigm. Multi-organ screening could be achieved by targeting markers within or stemming from the circulation (including blood, urine, saliva, and expired breath) or those exfoliated into common excretory pathways (including the gastrointestinal and female reproductive tracts). Rigorous clinical studies in intended use populations and collaborations between academia, industry, professional societies, and government will be required to bring this lofty vision to a population application.