Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study.
Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study.
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DOI：
10.1016/s1470-2045(08)70104-9
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发表时间：
2008-05
期刊：
影响因子：
51.1
通讯作者：
Donovan, Jenny
中科院分区：
文献类型：
--
作者：
Collin, Simon M.;Martin, Richard M.;Metcalfe, Chris;Gunnell, David;CAlbertsen, Peter;Neal, David;Hamdy, Freddie;Stephens, Peter;Lane, J. Athene;Moore, Rollo;Donovan, Jenny
没有确凿证据表明，基于前列腺特异性抗原(PSA)检测的筛查可以降低前列腺癌死亡率。在美国，PSA检测的普及速度很快，但在英国要少得多。调查1975-2004年美国和英国前列腺癌死亡率和发病率的趋势，并将其与筛查和治疗的趋势进行对比。英国癌症研究所和美国国家癌症研究所监测流行病学和最终结果(SEER)计划的癌症死亡率统计数据的连接点回归分析被用来估计每个国家和地区前列腺癌死亡率的年度百分比变化以及趋势变化的时间点。在20世纪90年代初，两个国家的年龄特定和年龄调整的前列腺癌死亡率达到峰值，几乎相同，但美国的年龄调整死亡率随后每年下降4.2%(95%可信区间4.0-4.3%)，是英国下降速度(1.1%；0.8%-1.4%)的四倍。在≥的75年中，美国的死亡率下降幅度最大、持续时间最长，而英国这一年龄段的死亡率到2000年已趋于平稳。1994年至2004年间，与英国相比，美国的前列腺癌死亡率显著下降，而与此同时，美国的PSA筛查接受率要高得多。对死亡率不同趋势的解释包括：最初的筛查可能对美国更具侵袭性的无症状疾病的男性产生早期影响，两国的治疗方法不同，以及与死因错误归因有关的偏见。在随机对照试验的证据公布之前，关于筛查作用的猜测将继续下去。
There is no conclusive evidence that screening based on prostate-specific antigen (PSA) tests reduces prostate cancer mortality. In the USA uptake of PSA testing has been rapid, but is much less common in the UK. To investigate trends in prostate cancer mortality and incidence in the USA and UK from 1975-2004, contrasting these with trends in screening and treatment. Joinpoint regression analysis of cancer mortality statistics from Cancer Research UK and the USA National Cancer Institute Surveillance Epidemiology and End Results (SEER) program was used to estimate the annual percentage change in prostate cancer mortality in each country and the points in time when trends changed. Age-specific and age-adjusted prostate cancer mortality peaked in the early 1990s at almost identical rates in both countries, but age-adjusted mortality in the USA subsequently declined by 4.2% (95% CI 4.0-4.3%) per annum, four times the rate of decline in the UK (1.1%; 0.8-1.4%). The mortality decline in the USA was greatest and most sustained in those ≥75 years, whereas death rates had plateaued in this age group in the UK by 2000. The striking decline in prostate cancer mortality in the USA compared with the UK between 1994-2004 coincided with much higher uptake of PSA screening in the USA. Explanations for the different trends in mortality include the possibility of an early impact of initial screening rounds on men with more aggressive asymptomatic disease in the USA, different approaches to treatment in the two countries, and bias related to the misattribution of cause of death. Speculation over the role of screening will continue until evidence from randomised controlled trials is published.