The elusive goal of maintaining population cancer screening: it is time for a new paradigm.
The elusive goal of maintaining population cancer screening: it is time for a new paradigm.
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维持人口癌症筛查这一难以实现的目标：是时候采取新的范式了。
DOI：
10.1093/jnci/djq240
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Buist,Diana
中科院分区：
文献类型：
--
作者：
Mandelblatt,Jeanne;Buist,Diana
总的来说，有多种复杂的影响因素会影响我们优化筛查的方法，从生物因素和个人行为到医疗机构和更广泛的政策环境。这些层次之间的联系和反馈很难用传统的方法来研究。计算机模拟建模整合了多个层面的干预结果和估计，这些投资可能对人口死亡率产生最大影响，同时平衡覆盖范围，效果，危害和成本。癌症干预和监测建模网络（CISNET）由国家癌症研究所（http：//cisnet.癌gov）是应用建模来确定最有利可图的干预途径的一个很好的例子（19）。乳腺癌筛查的承诺由于其不精确性，未能筛选那些风险最高的人，在推荐的时间段内缺乏对筛查持续性的依从性，以及诊断随访和治疗的获取或质量方面的差距而未能达到其目标（20）。仅仅进行更多的干预以了解哪种干预最能激励个人进行重复癌症筛查已经不够了。在模型、新试验和新科学发现的证据指导下，需要新的范式来实现消除癌症负担的承诺。引用
Overall, there are multiple complex influences that affect our approach to optimizing screening, ranging from biological factors and individual behavior to health-care organizations and the broader policy environment. Connections and feedback among these levels are difficult to study with traditional methods. Computer simulation modeling integrates outcomes of interventions across multiple levels and estimates, which investments are likely to have the maximum impact on population mortality while balancing reach, effects, harms, and costs. The Cancer Intervention and Surveillance Modeling Network (CISNET) funded by the National Cancer Institute (http://cisnet. cancer. gov) is an excellent example of the application of modeling to determine the most profitable avenues for intervention (19). The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer. references