Cancer screening recommendations: an international comparison of high income countries.
Cancer screening recommendations: an international comparison of high income countries.
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DOI：
10.1186/s40985-018-0080-0
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发表时间：
2018
影响因子：
5.5
通讯作者：
Royalty KJ
中科院分区：
文献类型：
--
作者：
Ebell MH;Thai TN;Royalty KJ
关于癌症筛查的建议因国家而异，也可能因国家而异，这取决于提出建议的组织。这项研究的目的是总结人均医疗保健支出最高的21个国家的癌症筛查建议。根据对医学文献的审查、互联网搜索以及与大多数国家的关键信息提供者的联系，确定了每个国家的癌症筛查指南。按照国家推荐、癌症协会推荐或医学专业协会推荐的顺序，为每个国家确定了最高级别的推荐。各国的乳腺癌筛查建议基本一致，最常见的是建议50至69岁或70岁的人每两年进行一次乳房X光检查。在美国，专业协会通常提供更密集的筛查建议。所有国家都建议进行宫颈癌筛查，尽管在检测（细胞学或HPV或两者）以及开始年龄和筛查间隔方面存在一些异质性。大多数国家建议使用粪便免疫化学（FIT）检测进行结直肠癌筛查，而只有7个国家建议对前列腺癌进行一般或选择性筛查，类似数量的国家明确建议不进行前列腺癌筛查。肺癌和皮肤癌的筛查只有少数国家推荐。更高的人均医疗支出与更高的筛查强度无关，前列腺癌可能除外。各国的癌症筛查指南各不相同，既有共同之处，也有明显的差异。对于乳腺癌和宫颈癌等成熟的癌症筛查计划，建议具有重要的共同点，各国之间在前列腺癌、结直肠癌、肺癌和皮肤癌筛查方面的差异较大。理想情况下，建议应该由一个专业多元化的独立专家小组提出，该专家小组根据该国的利益，危害和可用资源提出有关筛查的循证建议。
Recommendations regarding cancer screening vary from country to country, and may also vary within countries depending on the organization making the recommendations. The goal of this study was to summarize the cancer screening recommendations from the 21 countries with the highest per capita spending on healthcare. Cancer screening guidelines were identified for each country based on a review of the medical literature, internet searches, and contact with key informants in most countries. The highest level recommendation was identified for each country, in the order of national recommendation, cancer society recommendation, or medical specialty society recommendation. Breast cancer screening recommendations were generally consistent across countries, most commonly recommending mammography biennially from ages 50 to 69 or 70 years. In the USA, specialty societies generally offered more intensive screening recommendations. All countries also recommend cervical cancer screening, although there is some heterogeneity regarding the test (cytology or HPV or both) and the age of initiation and screening interval. Most countries recommend colorectal cancer screening using fecal immunochemical (FIT) testing, while only seven countries recommend general or selective screening for prostate cancer, and a similar number explicitly recommend against screening for prostate cancer. Screening for lung and skin cancer is only recommended by a few countries. Greater per capita healthcare expenditures are not associated with greater screening intensity, with the possible exception of prostate cancer. Guidelines for cancer screening differ between countries, with areas of commonality but also clear differences. Recommendations have important commonalities for well-established cancer screening programs such as breast and cervical cancer, with greater variation between countries regarding prostate, colorectal, lung, and skin cancer screening. Ideally, recommendations should be made by a professionally diverse, independent panel of experts that make evidence-based recommendations regarding screening based on the benefits, harms, and available resources in that country’s context.