Screening for cancer with computed tomography.
Screening for cancer with computed tomography.
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通过计算机断层扫描筛查癌症。
DOI：
10.1136/bmj.326.7395.894
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Swensen,StephenJ
中科院分区：
文献类型：
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作者：
Swensen,StephenJ
使用计算机断层扫描进行全身筛查是美国一项主要广告活动的重点。广告牌和广播广告上诱人的推荐信敦促公众使用这项技术，暗示有很多收获，但几乎没有什么损失。初级保健医生应该如何建议他们的病人？从某种意义上说，用计算机断层扫描进行筛查有很大的用处。作为美国国立卫生研究院进行的一项研究的一部分，我们的中心在过去四年里使用计算机断层扫描来筛查肺癌，并已确定了56种肺癌。足足有62%的非小细胞癌为IA期。1在没有筛查的情况下，只有15%-20%的肺癌出现在IA期。I期肺癌的五年生存率约为60%-70%，高于诊断为更晚期的癌症。毫无疑问，在检测早期小肺癌方面，计算机断层扫描比胸部X光更敏感。我们发现了两个直径只有3毫米的癌症。想到我们发现了56名肺癌患者，人们可能会问，为什么不应该提倡筛查。为什么要等到患者出现症状和晚期疾病？筛查可能在短短几年内拯救数十万人的生命。然而，一些不确定性使得提倡大规模使用计算机断层扫描进行筛查还为时过早。
Whole body screening with computed tomog-raphy is the focus of a major advertising campaign in the United States. Enticing testimonials on billboards and radio spots urge the public to use this technology, implying that there is much to gain and little to lose. How should primary care doctors advise their patients? In one sense screening with computed tomography has much to offer. As part of a study conducted by the National Institutes of Health, our centre has used computed tomography to screen for lung cancer for the past four years and has identified 56 lung cancers. Fully 62% of the non-small cell cancers were stage IA. 1 In the absence of screening, only 15-20% of lung cancers present at stage IA. Five year survival for stage I lung cancers, which is about 60-70%, is higher than for cancers diagnosed at more advanced stages. There is little doubt that computed tomography is more sensitive than chest x ray in detecting small, early stage lung cancers. We found two cancers measuring only 3 mm in diameter.Recognising that we found 56 patients with lung cancer, one could ask why screening should not be advocated. Why wait until patients develop symptoms and later stage disease? Screening could potentially save hundreds of thousands of lives in just a few years. Several uncertainties, however, make it premature to advocate screening on a large scale with computed tomography.