Early detection of disease and scheduling of screening examinations
Early detection of disease and scheduling of screening examinations
复制标题
DOI：
10.1191/0962280204sm377ra
复制
发表时间：
2004-01-01
影响因子：
2.3
通讯作者：
Zelen, M
中科院分区：
文献类型：
--
作者：
Lee, S;Huang, H;Zelen, M
许多慢性疾病都有特殊的检查，可以在疾病没有症状时诊断出来，没有任何体征或症状。及早发现疾病可能会导致更多的治愈或更长的生存期。这种可能性导致了公共卫生项目，这些项目建议人们定期进行筛查，以检测特定的慢性病，例如癌症、糖尿病、心血管疾病等。当这种检查计划嵌入到公共卫生计划中时，费用总是很高的，而且通常不是根据不同检查计划的成本和收益之间可能的权衡来选择的。检查计划可能的候选人数太多，不能通过临床试验来比较不同的检查计划。相反，这个问题可以通过开发一个理论模型来研究，该模型可以预测不同检查计划的最终疾病特定死亡率。我们已经开发了这样一个模型。它是一个随机模型，它假设：1)疾病的自然病程是渐进的，2)早期诊断的任何好处都是由于诊断时疾病阶段分布的变化(阶段转移)。该模型是通用的，可以应用于任何满足我们两个基本假设的慢性疾病。我们讨论了时间表敏感度和终生时间表敏感度的基本概念及其与降低疾病特定死亡率的关系。我们的理论通过乳腺癌筛查的应用得到了说明。时间表的调查不仅比较了两次考试之间间隔相等的考试时间表，而且还使用阈值方法比较了交错的时间表。(当个人的风险状况达到预先指定的阈值时，进行检查。)
Special examinations exist for many chronic diseases, which can diagnose the disease while it is asymptomatic, with no signs or symptoms. The earlier detection of disease may lead to more cures or longer survival. This possibility has led to public health programs which recommend populations to have periodic screening examinations for detecting specific chronic diseases, for example, cancer, diabetes, cardiovascular disease and so on. Such examination schedules when embedded in a public health program are invariably costly and are ordinarily not chosen on the basis of possible trade-offs in costs and benefits for different screening schedules. The possible candidate number of examination schedules is so large that it is not feasible to carry out clinical trials to compare different schedules. Instead, this problem can be investigated by developing a theoretical model which can predict the eventual disease specific mortality for different examination schedules. We have developed such a model. It is a stochastic model which assumes that i) the natural history of the disease is progressive and ii) any benefit from earlier diagnosis is due to a change in the distribution of disease stages at diagnosis (stage shift). The model is general and can be applied to any chronic disease which satisfies our two basic assumptions. We discuss the basic ideas of schedule sensitivity and lifetime schedule sensitivity and its relation to the reduction in disease specific mortality. Our theory is illustrated by applications to breast cancer screening. The investigation of schedules compares not only examination schedules with equal intervals between examinations but also staggered schedules using the threshold method. (Examinations are carried out when an individual's risk status reaches a preassigned threshold value.).