Screening for Thyroid Cancer US Preventive Services Task Force Recommendation Statement
Screening for Thyroid Cancer US Preventive Services Task Force Recommendation Statement
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DOI：
10.1001/jama.2017.4011
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发表时间：
2017-05-09
影响因子：
120.7
通讯作者：
Tseng, Chien-Wen
中科院分区：
文献类型：
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作者：
Bibbins-Domingo, Kirsten;Grossman, David C.;Tseng, Chien-Wen
在过去的10年中，甲状腺癌的发病率每年增加4.5%，比任何其他癌症都要快，但死亡率没有相应的变化。2013年，美国甲状腺癌的发病率为每10万人15.3例。大多数甲状腺癌病例预后良好;甲状腺癌的5年生存率为98.1%。目的更新美国预防服务工作组（USPSTF）关于甲状腺癌筛查的建议。证据综述USPSTF回顾了无症状成年人甲状腺癌筛查的益处和危害、筛查的诊断准确性、甲状腺癌筛查的有效性和有效性。（包括颈部触诊和超声），以及筛查检测到的甲状腺癌治疗的益处和危害。调查结果USPSTF发现筛查益处的直接证据不足，但确定筛查和治疗的总体益处的大小可以被限制为不大于小，考虑到甲状腺癌的相对罕见性，接受治疗的患者与接受监测的患者（对于最常见的肿瘤类型）之间的结果明显缺乏差异，并且观察证据显示，在引入大规模筛查计划后，死亡率随时间推移没有变化。USPSTF发现有关筛查危害的直接证据不足，但确定筛查和治疗危害的总体程度至少为中度，因为有足够的证据表明治疗危害，并且有间接证据表明过度诊断和过度治疗可能是基于人群的筛查。因此，USPSTF确定，筛查甲状腺癌的净效益是negative.CONCLUSIONS和建议USPSTF建议对无症状的成年人进行甲状腺癌筛查。（D建议）
IMPORTANCE The incidence of thyroid cancer detection has increased by 4.5% per year over the last 10 years, faster than for any other cancer, but without a corresponding change in the mortality rate. In 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100 000 persons. Most cases of thyroid cancer have a good prognosis; the 5-year survival rate for thyroid cancer overall is 98.1%.OBJECTIVE To update the US Preventive Services Task Force (USPSTF) recommendation on screening for thyroid cancer.EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for thyroid cancer in asymptomatic adults, the diagnostic accuracy of screening (including neck palpation and ultrasound), and the benefits and harms of treatment of screen-detected thyroid cancer.FINDINGS The USPSTF found inadequate direct evidence on the benefits of screening but determined that the magnitude of the overall benefits of screening and treatment can be bounded as no greater than small, given the relative rarity of thyroid cancer, the apparent lack of difference in outcomes between patients who are treated vs monitored (for the most common tumor types), and observational evidence showing no change in mortality over time after introduction of a mass screening program. The USPSTF found inadequate direct evidence on the harms of screening but determined that the overall magnitude of the harms of screening and treatment can be bounded as at least moderate, given adequate evidence of harms of treatment and indirect evidence that overdiagnosis and overtreatment are likely to be substantial with population-based screening. The USPSTF therefore determined that the net benefit of screening for thyroid cancer is negative.CONCLUSIONS AND RECOMMENDATION The USPSTF recommends against screening for thyroid cancer in asymptomatic adults. (D recommendation)