Advances in radiology and the real versus apparent effects of early diagnosis
Advances in radiology and the real versus apparent effects of early diagnosis
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DOI：
10.1016/s0720-048x(97)00160-5
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发表时间：
1998-05-01
影响因子：
3.3
通讯作者：
Black, WC
中科院分区：
文献类型：
--
作者：
Black, WC
在过去的二十年里，放射学的技术进步已经彻底改变了医学实践。虽然这些进步的潜在好处是众所周知的，但潜在的危害却没有。本文介绍了如何早期诊断可能会导致高估疾病的患病率和干预的有效性。本文首先展示了如何观察到的疾病的患病率增加与测试的灵敏度和解释的概念，假性疾病。接下来，本文解释了前置时间偏差，长度偏差和过度诊断偏差如何导致高估早期诊断和相关治疗的有效性。这些偏差与疾病的检测和分期有关。此外，该论文还解释了这些对疾病患病率和干预有效性的高估如何启动一个增加检测和治疗的循环，最终可能弊大于利。最后，随机临床试验和决策分析的背景下，评估新的测试策略进行了讨论。(C)1998爱思唯尔科学爱尔兰有限公司保留所有权利。
Over the last two decades, technological advances in radiology have revolutionized the practice of medicine. Although the potential benefits of these advances are well recognized, the potential harms are not. This paper describes how early diagnosis can cause overestimations of disease prevalence and the effectiveness of intervention. The paper begins by demonstrating how the observed prevalence of disease increases with the sensitivity of the test and by explaining the concept of pseudodisease. Next, the paper explains how lead time bias, length bias and overdiagnosis bias cause overestimations of the effectiveness of earlier diagnosis and associated treatments. These biases pertain to both the detection and staging of disease. In addition, the paper explains how these overestimations of disease prevalence and the effectiveness of intervention can initiate a cycle of increasing testing and treatment, which may eventually cause more harm than benefit. Finally, randomized clinical trials and decision analysis are discussed in the context of evaluating new testing strategies. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.