The impact of colorectal cancer screening on life expectancy
The impact of colorectal cancer screening on life expectancy
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DOI：
10.1016/s0016-5107(00)70282-3
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发表时间：
2000-05-01
影响因子：
7.7
通讯作者：
Sonnenberg, A
中科院分区：
文献类型：
--
作者：
Inadomi, JM;Sonnenberg, A
方法：本研究的目的是评估结直肠癌筛查对预期寿命的影响，并估计每挽救生命一年所需的结肠镜检查次数。使用预期寿命下降指数近似值来计算结直肠癌筛查对预期剩余寿命的影响，每年因结直肠癌死亡的人数和人口规模来自美国的人口动态统计。参考已发表的报告，确定通过粪便潜血检测、筛查乙状结肠镜检查或结肠镜检查所实现的结直肠癌死亡率的降低，使用马尔可夫链分析来确定筛查和调查 50 岁至死亡或 85 岁的整个美国居民人口所需的内窥镜资源。 结果：结直肠癌使 50 至 54 岁美国居民的预期寿命缩短 292 天，而老年人70 至 74 岁乘 70 天。使用粪便潜血测试进行筛查可将 2 个年龄组的预期寿命分别延长 51 天和 12 天，而使用乙状结肠镜进行筛查则可分别延长 86 天和 21 天。结肠镜筛查可使预期寿命分别延长 170 天和 41 天。挽救 1 年预期寿命所需的结肠镜检查次数为 2.9 至 6.0 次，具体取决于所使用的筛查方案的类型。结论：通过筛查性结肠镜检查延长的寿命分别比通过柔性乙状结肠镜检查或粪便潜血试验延长的寿命长两倍或三倍。尽管需要大量的结肠镜检查来筛查美国人口，但每延长预期寿命一年，需要投资的结肠镜检查相对较少。
Methods: The purpose of this study was to assess the effect of screening for colorectal cancer on life expectancy and estimate the number of colonoscopies needed per life year saved. The declining exponential approximation of life expectancy was used to calculate the effect of colorectal cancer screening on expected remaining lifetime, The annual number of deaths from colorectal cancer and the size of the population were obtained from the vital statistics of the United States. Published reports were consulted to determine the decrease in mortality from colorectal cancer achieved by fecal occult blood testing, screening sigmoidoscopy or colonoscopy, A Markov chain analysis was used to determine the endoscopic resources required to screen and survey the entire population of U.S. residents age 50 years until death or age 85 years.Results: Colorectal cancer decreases the life expectancy of U.S. residents aged 50 to 54 years by 292 days and those aged 70 to 74 years by 70 days. Screening with fecal occult blood tests extends expected lifetime of the 2 age groups by 51 and 12 days, respectively, whereas screening with sigmoidoscopy leads to increases of 86 and 21 days. Colonoscopic screening increases expected lifetime by 170 and 41 days, respectively. The number of colonoscopies needed to save 1 year of expected life ranges from 2.9 to 6.0, depending on the type of screening regimen used.Conclusions: The extension of life through screening colonoscopy is two or three times longer than the extension achieved through flexible sigmoidoscopy or fecal occult blood test, respectively. Although a large number of colonoscopies are required to screen the U.S. population, relatively few colonoscopies need to be invested per year of life expectancy saved.