Screening for Cancer: The Economic, Medical, and Psychosocial Issues
Screening for Cancer: The Economic, Medical, and Psychosocial Issues
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DOI：
10.37765/ajmc.2020.88534
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发表时间：
2020-11-01
影响因子：
3.2
通讯作者：
Brill, Joel, V
中科院分区：
文献类型：
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作者：
Brill, Joel, V
尽管在过去20年中死亡率有了显著改善，但癌症仍然是美国第二大死亡原因。死亡率改善的一个原因是在乳腺癌、宫颈癌、结直肠癌和前列腺癌的平均风险人群中筛查几种常见癌症，以及在有20多包年病史的人群中筛查肺癌。当癌症最有可能对治疗有反应时，这种筛查可能导致早期诊断。然而，对于平均风险患者中的大多数癌症，没有基于人群的筛查建议，其中大多数直到后期才被诊断出来。一个问题是，早期诊断是否不仅可以降低死亡率，还可以降低医疗费用。筛查伴随着几个潜在的风险，包括假阳性和过度诊断，这两者都可能影响患者的心理健康，增加发病率和死亡率，并导致过度支出。此外，某些癌症可以逃避传统的筛查测试，导致假阴性结果，这会延迟癌症的检测和治疗，并可能影响治疗效果。液体活检测试的出现可以筛查数十种癌症，这为早期发现更多癌症提供了希望。然而，成本，过度诊断和假阳性的可能性，以及缺乏证据证明临床实用性或改善健康结果，使人们对它们用于广泛筛查的潜在用途提出了质疑。政府和管理式医疗机构在确定覆盖范围时需要考虑这些检测的风险和益处。
Despite significant improvements in mortality over the past 20 years, cancer remains the second leading cause of death in the United States. One reason for the improvement in mortality is screening for several common cancers in people at average risk for breast, cervical, colorectal, and prostate cancers, and screening for lung cancer in those with a 20-plus pack-year history. Such screening may result in earlier diagnosis when the cancer is most likely to respond to treatment. However, there are no population-based screening recommendations for the majority of cancers in average-risk patients, most of which are not diagnosed until the later stages. One question is whether earlier diagnosis could not only reduce mortality rates but also reduce medical costs. Screening comes with several potential risks, including false positives and overdiagnosis, both of which can affect patients' mental health, increase morbidity and mortality, and lead to excess spending. Additionally, certain cancers can evade traditional screening tests and lead to false-negative results, which delays cancer detection, treatment, and may affect treatment efficacy. The advent of liquid biopsy tests that could screen for dozens of cancers holds promise for identifying more cancers early. However, the cost, the potential for overdiagnosis and false positives, and a lack of evidence demonstrating clinical utility or an improvement in health outcomes call into question their potential use for widespread screening. Government and managed care organizations will need to consider the risks and benefits of these assays in determining coverage.