Cancer surveillance series: Interpreting trends in prostate cancer - Part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates
Cancer surveillance series: Interpreting trends in prostate cancer - Part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates
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DOI：
10.1093/jnci/91.12.1017
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发表时间：
1999-06-16
影响因子：
10.3
通讯作者：
Kaplan, RS
中科院分区：
文献类型：
--
作者：
Hankey, BF;Feuer, EJ;Kaplan, RS
工作背景：前列腺特异性抗原测试于1986年被美国食品和药物管理局批准用于监测前列腺癌患者的疾病状态，并于1994年帮助前列腺癌检测。然而，在1986年之后，许多以前没有被诊断出患有前列腺癌的男性进行了测试，显然导致了大量早期肿瘤的诊断。我们的目的是深入了解筛查对前列腺癌发病率的影响，提供了白人的详细数据，因为人口规模允许计算统计学上可靠的发病率;然而，非洲裔美国人和其他种族的总体趋势相似。研究方法：分析了来自国家癌症研究所的监测、流行病学和最终结果计划的前列腺癌发病率数据和来自国家卫生统计中心的死亡率数据。结果/结论：以下发现与筛查效应一致：1）自1991年以来，在没有受到筛查干扰后，远发期疾病的发病率最近有所下降; 2）从次年开始的早期疾病发病率下降（即，1992年）; 3）前列腺癌发病率和死亡率最近的增加和减少，似乎表明一个日历周期的影响;和4）通过肿瘤分级的远距离期疾病的发生率的趋势和患者存活率的趋势，vith遥远阶段疾病的日历年，提供提示性证据的趋势，筛选，以检测生长较慢的肿瘤，影响：在遥远的阶段疾病的发病率下降持有的承诺，检测前列腺特异性抗原可能会导致前列腺癌死亡率持续下降。然而，人口数据很复杂，很难自信地将死亡率相对较小的变化归因于任何一种原因。
Background: The prostate-specific antigen test was approved by the U.S. Food and Drug Administration in 1986 to monitor the disease status in patients with prostate cancer and, in 1994, to aid in prostate cancer detection. However, after 1986, the test was performed on many men who had not been previously diagnosed with prostate cancer, apparently resulting in the diagnosis of a substantial number of early tumors. Our purpose is to provide insight into the effect of screening on prostate cancer rates, Detailed data are presented for whites because the size of the population allows for calculating statistically reliable rates; however, similar overall trends are seen for African-Americans and other races. Methods: Prostate cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and mortality data from the National Center for Health Statistics were analyzed, Results/Conclusions: The following findings are consistent with a screening effect: 1) the recent decrease since 1991 in the incidence of distant stage disease, after not having been perturbed by screening; 2) the decline in the incidence of earlier stage disease beginning the following year (i.e,, 1992); 3) the recent increases and decreases in prostate cancer incidence and mortality by age that appear to indicate a calendar period effect; and 4) trends in the incidence of distant stage disease by tumor grade and trends in the survival of patients,vith distant stage disease by calendar year that provide suggestive evidence of the tendency of screening to detect slower growing tumors, Implications: The decline in the incidence of distant stage disease holds the promise that testing for prostate-specific antigen may lead to a sustained decline in prostate cancer mortality. However, population data are complex, and it is difficult to confidently attribute relatively small changes in mortality to any one cause.