CT screening for lung cancer: Update 2007
CT screening for lung cancer: Update 2007
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DOI：
10.1634/theoncologist.2007-0153
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发表时间：
2008-01-01
期刊：
影响因子：
5.8
通讯作者：
Yankelevitz, David F.
中科院分区：
文献类型：
--
作者：
Henschke, Claudia I.;Yankelevitz, David F.
筛查是追求在症状出现之前早期诊断癌症。早期诊断的目的是提供早期治疗，这可能会防止癌症死亡。筛查的有效性取决于癌症的早期诊断和早期治疗与晚期诊断和治疗相比可以预防多少死亡。早期肺癌行动计划研究人员的目标是开发一种有效的方法，为评估新兴的癌症筛查新技术提供不断积累，不断更新的证据。这种方法认识到，筛查是一个连续的过程，从追求癌症的早期诊断开始，然后进行早期治疗。它还认识到，诊断研究与治疗研究有着根本的不同。为了充分理解目前关于肺癌筛查证据的讨论，提供了关键定义，包括第一轮基线筛查与所有后续重复筛查之间的区别，以及基线和重复癌症及其按细胞类型的分布。这些定义在分析各种筛查报告的结果时至关重要，因为它们并不被所有人使用。为了提供最佳的筛查，必须指定诊断检查的方案，从初始测试的定义开始，其阳性结果，以及导致癌症诊断的阳性结果的检查。诊断性能的评估不需要对照组，但需要确认诊断。为了评估早期治疗的有效性，需要对照组。对照组可以通过随机分配筛查诊断为肺癌的人立即或延迟治疗来形成，就像前列腺癌一样。这提供了对筛查导致的癌症的任何潜在过度诊断的直接评估。或者，可以使用一个准实验对照组，由被诊断患有癌症的参与者组成，他们拒绝或延迟治疗，即使他们是候选人。
Screening is the pursuit of the early diagnosis of cancer before symptoms occur. The purpose of early diagnosis is to provide early treatment, which potentially prevents death from the cancer. The usefulness of screening depends on how early the cancer can be diagnosed and how many deaths can be prevented by early treatment as compared with later symptom-prompted diagnosis and treatment.The goal of the Early Lung Cancer Action Project investigators was to develop an efficient methodology that would provide an ever-accumulating, continually updated body of evidence for evaluation of emerging new technologies for screening for cancer. This methodology recognizes that screening is a sequential process that starts with the pursuit of the early diagnosis of cancer followed by early treatment. It also recognizes that diagnostic research is fundamentally different from treatment research. To fully understand the current discussions on the evidence for lung cancer screening, key definitions are provided, including the differentiation between the first, baseline round of screening and all subsequent rounds of repeat screening and baseline and repeat cancers and their distribution by cell type. These definitions are critical in analyzing the results of various screening reports as they are not used by all.To provide optimal screening, a regimen for the diagnostic workup must be specified starting with the definition of the initial test, its positive result, and the workup for a positive result leading to a diagnosis of cancer. Assessment of diagnostic performance does not require a control group, but does require confirmation of the diagnosis.For assessment of the effectiveness of early treatment, a comparison group is needed. The comparison group may be formed by randomly assigning people with screen-diagnosed lung cancer to immediate or delayed treatment, as has been done for prostate cancer. This provides a direct assessment of any potential overdiagnosis of the cancer resulting from screening. Alternatively, a quasiexperimental control group can be used consisting of participants diagnosed with the cancer who have refused or delayed their treatment even though they are candidates for it.