Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark
Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark
复制标题
DOI：
10.1136/bmj.e8441
复制
发表时间：
2013-01-08
影响因子：
105.7
通讯作者：
Walter, Louise C.
中科院分区：
文献类型：
--
作者：
Lee, Sei J.;Boscardin, W. John;Walter, Louise C.
目的确定乳腺癌或结直肠癌筛查后在观察到生存益处之前所需时间的综合定量估计。设计对基于人群的随机对照试验的生存数据的荟萃分析，比较筛查和未筛查乳腺癌或结直肠癌的人群。通过Cochrane协作和美国预防服务工作组的审查，试验被确定为高质量。设置在美国、丹麦、英国和瑞典进行的试验。人口筛查40岁以上的患者。主要结果衡量筛查和对照人群中因乳腺癌或结直肠癌死亡的时间。用于结直肠癌筛查的粪便潜血试验，用于乳腺癌筛查的乳房X光检查。结果我们的研究分别纳入了5项和4项乳腺癌和结直肠癌筛查的合格试验。对于乳腺癌筛查，每5000名接受筛查的妇女中，预防一例乳腺癌死亡的时间间隔为3.0年(95%可信区间1.1至6.3)。在所有纳入的研究中，平均需要10.7年(4.4到21.6年)才能防止1000名接受筛查的女性死于乳腺癌。对于结直肠癌筛查，在接受筛查的5000名患者中，4.8年(2.0至9.7)年后预防了一例结直肠癌死亡。在纳入的研究中，平均需要10.3年(6.0-16.4年)才能预防1000名患者死于结直肠癌。结论我们的研究结果表明，乳腺癌和结直肠癌筛查最适合预期寿命大于10年的患者。将时间滞后估计纳入筛查指南将鼓励更明确地考虑乳腺癌和结直肠癌筛查的风险和好处。
Objectives To determine a pooled, quantitative estimate of the length of time needed after breast or colorectal cancer screening before a survival benefit is observed.Design Meta-analysis of survival data from population based, randomized controlled trials comparing populations screened and not screened for breast or colorectal cancer. Trials were identified as high quality by reviews from the Cochrane Collaboration and United States Preventive Services Task Force.Setting Trials undertaken in the United States, Denmark, United Kingdom, and Sweden.Population Screened patients older than 40 years.Primary outcome measures Time to death from breast or colorectal cancer in screened and control populations.Interventions Fecal occult blood testing for colorectal cancer screening, mammography for breast cancer screening.Results Our study included five and four eligible trials of breast and colorectal cancer screening, respectively. For breast cancer screening, 3.0 years (95% confidence interval 1.1 to 6.3) passed before one death from breast cancer was prevented for every 5000 women screened. On average across included studies, it took 10.7 years (4.4 to 21.6) before one death from breast cancer was prevented for 1000 women screened. For colorectal cancer screening, 4.8 years (2.0 to 9.7) passed before one death from colorectal cancer was prevented for 5000 patients screened. On average across included studies, it took 10.3 years (6.0 to 16.4) before one death from colorectal cancer was prevented for 1000 patients screened.Conclusions Our results suggest that screening for breast and colorectal cancer is most appropriate for patients with a life expectancy greater than 10 years. Incorporating time lag estimates into screening guidelines would encourage a more explicit consideration of the risks and benefits of screening for breast and colorectal cancer.