Biomarkers in cancer screening: A public health perspective
Biomarkers in cancer screening: A public health perspective
复制标题
DOI：
10.1093/jn/132.8.2471s
复制
发表时间：
2002-08-01
影响因子：
4.2
通讯作者：
Gopal-Srivastava, R
中科院分区：
文献类型：
--
作者：
Srivastava, S;Gopal-Srivastava, R
过去三十年见证了卫生服务技术的迅速发展和普及。技术创新使保健服务提供者能够诊断和治疗越来越多的疾病，包括癌症。在这项努力中，癌症检测和风险评估的生物标志物研究已经成为我们减少癌症死亡努力的中心阶段。科学家们第一次有了破译和理解这些生物标志物的技术，并将它们应用于早期癌症检测。通过确定患癌风险高的人群，就有可能制定预防而不是治疗的干预措施。一旦得到充分开发和验证，那么生物标志物在早期检测和风险评估中的常规临床应用将满足国家公认的医疗保健需求：在早期阶段检测癌症。过去三十年来医疗保健费用的急剧上升部分与新技术的扩散有关。最近的分析表明，诸如新程序、新产品和新能力等技术变化是支出历史增加的主要原因。生物标志物是这个竞争环境中的新进入者。生物标志物被认为是一种竞争性的、中间的或附加的技术。与计算机断层扫描（CT）和其他射线照相相比，生物标记物的实验室测试等技术的成本更低。然而，用于早期检测和风险评估的生物标志物尚未达到临床应用所需的置信度水平。本文讨论了与生物标志物开发、验证和质量保证有关的一些问题。从市场份额的角度对诊断技术、蛋白质组学和基因组学的发展趋势进行了介绍和讨论。最终，在医疗保健中使用生物标志物可以通过提供无创、敏感和可靠的分析来降低成本，而成本只是CT扫描等确定技术的一小部分。美国国家癌症研究所的早期检测研究网络（EDRN）开始了一项由研究人员发起的创新项目，以改进检测癌细胞生物标志物的方法。EDRN是一个由超过32个机构组成的联盟，旨在将生物标记物的发现与开发早期检测测试过程的下一步联系起来。这些发现将有助于提高测试的准确性和可靠性的早期临床验证。
The last three decades have witnessed a rapid advancement and diffusion of technology in health services. Technological innovations have given health service providers the means to diagnose and treat an increasing number of illnesses, including cancer. In this effort, research on biomarkers for cancer detection and risk assessment has taken a center stage in our effort to reduce cancer deaths. For the first time, scientists have the technologies to decipher and understand these biomarkers and to apply them to earlier cancer detection. By identifying people at high risk of developing cancer, it would be possible to develop intervention efforts on prevention rather than treatment. Once fully developed and validated, then the regular clinical use of biomarkers in early detection and risk assessment will meet nationally recognized health care needs: detection of cancer at its earliest stage. The dramatic rise in health care costs in the past three decades is partly related to the proliferation of new technologies. More recent analysis indicates that technological change, such as new procedures, products and capabilities, is the primary explanation of the historical increase in expenditure. Biomarkers are the new entrants in this competing environment. Biomarkers are considered as a competing, halfway or add-on technology. Technology such as laboratory tests of biomarkers will cost less compared with computed tomography (CT) scans and other radiographs. However, biomarkers for earlier detection and risk assessment have not achieved the level of confidence required for clinical applications. This paper discusses some issues related to biomarker development, validation and quality assurance. Some data on the trends of diagnostic technologies, proteomics and genomics are presented and discussed in terms of the market share. Eventually, the use of biomarkers in health care could reduce cost by providing noninvasive, sensitive and reliable assays at a fraction of the cost of definitive technology, such as CT scan. The National Cancer Institute's Early Detection Research Network (EDRN) has begun an innovative, investigator-initiated project to improve methods for detecting the biomarkers of cancer cells. The EDRN is a consortium of more than 32 institutions to link discovery of biomarkers to the next steps in the process of developing early detection tests. These discoveries will lead to early clinical validation of tests with improved accuracy and reliability.