Conflicts and contradictions in current skin cancer screening guidelines.
Conflicts and contradictions in current skin cancer screening guidelines.
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DOI：
10.1007/s13671-017-0205-6
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发表时间：
2017-12
影响因子：
1.6
通讯作者：
Cockburn M
中科院分区：
文献类型：
--
作者：
Wojcik KY;Escobedo LA;Miller KA;Hawkins M;Ahadiat O;Higgins S;Wysong A;Cockburn M
审查主要公共卫生/医疗组织的皮肤癌筛查指南。对于是否有必要进行筛查以预防皮肤癌，目前还没有达成共识。筛查有效性的最佳证据应该来自基于人群的随机试验，但由于可行性限制，不太可能存在。因此，应该从观察性/非随机化设计中建立共识，例如德国的Screen研究。目前的指南通常只关注黑色素瘤，而筛查非黑色素瘤皮肤癌(NMSC)的潜在好处在很大程度上被忽视了。如果两种疾病都被考虑进去，筛查的价值可能就没有那么大的怀疑余地了。此外，有针对性的方法，即只在高危人群中进行筛查，仍然定义不明确，也没有经过测试。继续声称没有足够的证据建议筛查，导致对是否进行筛查的困惑，而且不太可能导致NMSC发病率的实质性变化和黑色素瘤的显著死亡。
To review skin cancer screening guidelines from major public health/medical organizations. No consensus exists on whether or not screening to prevent skin cancer is warranted. The best evidence of screening efficacy should come from population-based randomized trials, but is unlikely to exist due to feasibility constraints. Consequently, consensus should be built from observational/non-randomized designs, such as the SCREEN study in Germany. Current guidelines often focus on melanoma alone, while potential benefits of screening for non-melanoma skin cancers (NMSC) are largely overlooked. There may be less room for doubt regarding the value of screening, if both diseases were considered. Further, targeted approaches, i.e. screening only in high-risk populations, remain poorly defined and untested. Continuing to state that there is insufficient evidence to recommend screening leads to confusion about whether or not to screen, and is unlikely to result in substantial changes to the morbidity of NMSC and significant mortality from melanoma.