Screening men for prostate and colorectal cancer in the United States - Does practice reflect the evidence?
Screening men for prostate and colorectal cancer in the United States - Does practice reflect the evidence?
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DOI：
10.1001/jama.289.11.1414
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发表时间：
2003-03-19
影响因子：
120.7
通讯作者：
Woloshin, S
中科院分区：
文献类型：
--
作者：
Sirovich, BE;Schwartz, LM;Woloshin, S
背景关于前列腺特异性抗原（PSA）筛查前列腺癌的有效性的争论在医学文献和媒体中得到了大量的关注，但男性实际接受筛查的程度尚不清楚。如果实践是以证据为基础的，PSA筛查在男性中将不如结肠直肠癌筛查普遍，结肠直肠癌筛查是一种广泛接受和证实efficacy.Objective的预防服务，比较PSA和结肠直肠癌筛查在美国男性中的患病率。美国疾病控制和预防中心对美国成年人进行的一项年度人口电话调查显示，用于收集来自所有50个州和哥伦比亚特区的40岁或以上男性的代表性样本的数据（n=49315）主要结果测量曾经筛查过前列腺癌的男性比例和最新筛查前列腺癌的男性比例（PSA检测）和结直肠癌（通过粪便潜血试验、可弯曲乙状结肠镜检查或结肠镜检查）。男性更有可能报告曾接受过前列腺癌筛查，而不是结直肠癌筛查; 75%的50岁或以上的人曾接受过PSA检测，而63%的人曾接受过任何结直肠癌检测（风险比[RR]，1.20; 95%置信区间[CI]，1.18-1.21）。对于所有年龄段的男性来说，最新的PSA筛查也比结直肠癌筛查更常见。在50至69岁的男性中（对筛查有最大共识的人），54%报告了最新的PSA筛查，而45%报告了最新的结直肠癌检测（RR，1.19; 95%CI，1.16-1.21）。在国家层面的分析，这个年龄组，男性显着更有可能是最新的前列腺癌筛查结直肠癌筛查相比，在27个州，而最新的结直肠癌筛查是更常见的，只有1个state.Conclusion在美国的男性中，前列腺癌筛查是更常见的结直肠癌筛查。医生应确保选择接受癌症筛查的男性了解结直肠癌筛查的已知死亡率益处和前列腺癌筛查的不确定益处。
Context The debate about the efficacy of prostate-specific antigen (PSA) screening for prostate cancer has received substantial attention in the medical literature and the media, but the extent to which men are actually screened is unknown. If practice were evidence-based, PSA screening would be less common among men than colorectal cancer screening, a preventive service of broad acceptance and proven efficacy.Objective To compare the prevalences of PSA and colorectal cancer screening among US men.Design, Setting, and Population The 2001 Behavioral Risk Factor Surveillance System, an annual population-based telephone survey of US adults conducted by the Centers for Disease Control and Prevention, was used to gather data on a representative sample of men aged 40 years or older from all 50 states and the District of Columbia (n=49315).Main Outcome Measures Proportions of men ever screened and up to date on screening for prostate cancer (with PSA testing) and colorectal cancer (with fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy).Results Overall, men are more likely to report having ever been screened for prostate cancer than for colorectal cancer; 75% of those aged 50 years or older have had a PSA test vs 63% for any colorectal cancer test (risk ratio [RR], 1.20; 95% confidence interval [CI], 1.18-1.21). Up-to-date PSA screening is also more common than colorectal cancer screening for men of all ages. Among men aged 50 to 69 years (those for whom there is the greatest consensus in favor of screening), 54% reported an up-to-date PSA screen, while 45% reported up-to-date testing for colorectal cancer (RR, 1.19; 95% CI, 1.16-1.21). In state-level analyses of this age group, men were significantly more likely to be up to date on prostate cancer screening compared with colorectal cancer screening in 27 states, while up-to-date colorectal cancer screening was more common in only 1 state.Conclusion Among men in the United States, prostate cancer screening is more common than colorectal cancer screening. Physicians should ensure that men who choose to be screened for cancer are aware of the known mortality benefit of colorectal cancer screening and the uncertain benefits of screening for prostate cancer.