Personalized cancer screening: helping primary care rise to the challenge.
Personalized cancer screening: helping primary care rise to the challenge.
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DOI：
10.1186/s40985-018-0083-x
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发表时间：
2018
影响因子：
5.5
通讯作者：
Cornuz J
中科院分区：
文献类型：
--
作者：
Selby K;Bartlett-Esquilant G;Cornuz J
凭借纵向患者关系，初级保健医生及其护理团队在促进预防医学（包括癌症筛查）方面具有独特的地位。各种力量的汇合正在推动对癌症筛查建议个性化的需求。建议越来越多地基于个体患者的偏好、病史、遗传和环境风险因素以及与医疗保健系统的互动水平。目前的例子包括结肠镜检查，粪便检测和结肠直肠癌（CRC）筛查的新兴测试之间的选择;在子宫颈癌筛查中使用遗传信息和家庭自我检测的可用性;多个风险因素和患者偏好的整合，以决定乳腺癌筛查的强度和长度;以及在决定是否进行肺癌筛查时戒烟和竞争优先事项的问题。这些变化将不可避免地增加初级保健的负担，为患者提供高质量的癌症筛查。为了解决这个问题，初级保健医生需要获得不断更新的证据审查，包括优先考虑强烈支持的建议，共享决策和偏好诊断工具的培训，以及允许人口健康管理和团队护理的电子健康记录（EHR）和报销模式。只有在基层医疗中加强癌症筛查，我们才能确保个性化癌症筛查的可及性和循证性。
With their longitudinal patient relationships, primary care physicians and their care teams are uniquely situated to promote preventive medicine, including cancer screening. A confluence of forces is driving the demand for the personalization of cancer screening recommendations. Recommendations are increasingly based on individual patient preferences, medical history, genetic and environmental risk factors, and level of interaction with the healthcare system. Current examples include choices between colonoscopy, fecal testing, and emerging tests for colorectal cancer (CRC) screening; the use of genetic information and availability of home self-testing in cervical cancer screening; the integration of multiple risk factors and patient preferences to decide the intensity and length of breast cancer screening; and the issues of smoking cessation and competing priorities when deciding whether or not to pursue lung cancer screening. These changes will inevitably increase the burden on primary care of providing high-quality cancer screening to their patients. To address, primary care physicians need access to continuously updated evidence reviews including prioritization of strongly supported recommendations, training in shared decision-making and tools for preference diagnosis, and an electronic health record (EHR) and reimbursement model that allow for population health management and team-based care. Only by reinforcing cancer screening in primary care can we ensure that personalized cancer screening is accessible and evidence-based.