Expected population impacts of discontinued prostate-specific antigen screening.
Expected population impacts of discontinued prostate-specific antigen screening.
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DOI：
10.1002/cncr.28932
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发表时间：
2014-11-15
期刊：
影响因子：
6.2
通讯作者：
Cooperberg, Matthew R.
中科院分区：
文献类型：
--
作者：
Gulati, Roman;Tsodikov, Alex;Etzioni, Ruth;Hunter-Merrill, Rachel A.;Gore, John L.;Mariotto, Angela B.;Cooperberg, Matthew R.
前列腺特异性抗原（PSA）筛查前列腺癌有很高的过度诊断风险，特别是在老年男性中，筛查试验的报告表明，在11-13年的随访后，它挽救的生命很少。新的临床指南建议不要对所有男性或70岁以上的男性进行PSA筛查，但这些指南的预期人群影响尚未研究。在美国，利用重建的PSA筛查模式和前列腺癌发病率建立了两种前列腺癌的自然病史和诊断模型。假设PSA筛查的生存获益与筛查试验一致，我们使用该模型预测2013-2025年期间所有男性或70岁以上男性在继续PSA筛查和停止PSA筛查下的发病率和死亡率。这些模型预测，在2013年至2025年期间，如果继续保持最近的筛查率，将会有71万至112万（模型之间的范围）男性被过度诊断，但将避免3.6万至5.7万例癌症死亡。停止对所有男性进行筛查可以100%消除过度诊断，但不能100%预防可避免的癌症死亡。对70岁以下男性的持续筛查消除了64-66%的过度诊断，但未能预防36-39%本可避免的癌症死亡。停止对所有男性进行PSA筛查可能会导致许多本可避免的癌症死亡。对70岁以下的男性继续进行PSA筛查可以预防一半以上可避免的癌症死亡，同时与对所有年龄段的男性继续进行PSA筛查相比，大大减少了过度诊断。
Prostate-specific antigen (PSA) screening for prostate cancer has high risks of overdiagnosis, particularly in older men, and reports from screening trials indicate that it saves few lives after 11–13 years of follow-up. New clinical guidelines recommend against PSA screening for all men or for men over 70 years, but expected population effects of these guidelines have not been studied. Two models of prostate cancer natural history and diagnosis were previously developed using reconstructed PSA screening patterns and prostate cancer incidence in the US. Assuming a survival benefit of PSA screening consistent with the screening trials, we used the models to predict incidence and mortality rates for the period 2013–2025 under continued PSA screening and under discontinued PSA screening for all men or for men over 70 years. The models predict that continuation of recent screening rates will overdiagnose 710,000–1,120,000 (range between models) men but will avoid 36,000–57,000 cancer deaths over the period 2013–2025. Discontinued screening for all men eliminates 100% of overdiagnoses but fails to prevent 100% of avoidable cancer deaths. Continued screening for men under 70 eliminates 64–66% of overdiagnoses but fails to prevent 36–39% of avoidable cancer deaths. Discontinuing PSA screening for all men may generate many avoidable cancer deaths. Continuing PSA screening for men under 70 years could prevent more than half of these avoidable cancer deaths while dramatically reducing overdiagnoses relative to continued PSA screening for all ages.
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影响因子：
39.2
作者：
Gulati R;Gore JL;Etzioni R
通讯作者：
Etzioni R
影响因子：
3.6
作者：
Etzioni, Ruth;Gulati, Roman;Penson, David F.
通讯作者：
Penson, David F.
DOI：
10.1158/1055-9965.epi-08-0784
发表时间：
2009-03
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Fesinmeyer MD;Gulati R;Zeliadt S;Weiss N;Kristal AR;Etzioni R
通讯作者：
Etzioni R
影响因子：
7.2
作者：
Gulati, Roman;Mariotto, Angela B.;Etzioni, Ruth
通讯作者：
Etzioni, Ruth
影响因子：
158.5
作者：
Bill-Axelson, Anna;Holmberg, Lars;Johansson, Jan-Erik
通讯作者：
Johansson, Jan-Erik