Commentary: case-control studies of screening for colorectal cancer: tailoring the design and analysis to the specific research question.
Commentary: case-control studies of screening for colorectal cancer: tailoring the design and analysis to the specific research question.
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评论：结直肠癌筛查的病例对照研究：根据具体研究问题定制设计和分析。
DOI：
10.1097/ede.0b013e3182a777b2
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Weiss,NoelS
中科院分区：
文献类型：
--
作者：
Weiss,NoelS
©2013 Lippincott Williams&Wilkins www.前言。虽然永远不能知道某一特定个体的癌前病变的发生时间，也无法知道其向恶性病变转变的时间，但可以通过对息肉和结直肠癌患病率的了解以及对息肉和癌症发病率的估计来估计这些情况。6在实践中，可以进行若干分析，每一种分析都基于对可检测到的癌前病变持续时间的不同似是而非的估计。必须记住，与特定形式的结直肠癌筛查相关的发病率的降低可能与死亡率的降低并不是密切对应的。那些由自然病史较长的癌前病变引起的癌症--也就是最适合通过检测和清除前体来预防的癌症--也可能是变得恶性后进展最慢的，因此也是最可治愈的。因此，筛查与死亡相关的相对风险可能比发病率更高(提示保护较少)。另一方面，一些检查(例如，那些试图识别粪便潜血的检查)对早期癌症的存在可能比对息肉的存在具有更高的敏感性，因此这种筛查对结直肠癌发病率的影响可能比这种疾病的死亡率小得多。
© 2013 Lippincott Williams & Wilkins www. epidem. com| 895 although the onset of the development of a premalignant lesion can never be known in a given individual, nor the time of its transition to a malignant lesion, these can be estimated from knowledge of the prevalence of polyps and colorectal cancer, together with estimates of the incidence of polyps and cancer. 6 In practice, several analyses can be performed, each based on a different plausible estimate of the duration of the detectable premalignant lesion. It must be kept in mind that the reduction in incidence associated with a given form of screening for colorectal cancer may not closely correspond to the reduction in mortality. those cancers that arise from premalignant lesions with a lengthy natural history—the very cancers most amenable to prevention by means of precursor detection and removal—may also be the slowest to progress after becoming malignant, and thus be the most curable. For this reason, the screeningassociated relative risk for mortality may be higher (suggesting less protection) than that for incidence. on the other hand, some tests (eg, those seeking to identify fecal occult blood) may have a greater sensitivity for the presence of early cancer than they do for the presence of polyps, and so the impact of such screening on the incidence of colorectal cancer may be substantially less than on mortality from this disease.