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結腸直腸がんのスクリーニング:科学的なレビュー
Judith M E Walsh1, Jonathan P Terdiman
1Division of General Internal Medicine, Department of Medicine, Women's Health Clinical Research Center, University of California San Francisco, Campus Box 1793, 1635 Divisadero Suite 600, San Francisco, CA 94115, USA. Jwalsh@medicine.ucsf.edu
JAMA
|March 14, 2003
まとめ
定期的な結腸直腸がんスクリーニングは,死亡率を大幅に低減します. 糞便の隠蔽血液検査や大腸内視鏡検査などの様々なスクリーニング方法を根拠としているが,50歳以上の平均リスクのある人に対して,単一の検査が決定的に優れているわけではない.
科学分野:
- 胃腸内科 胃腸内科
- 予防医学は,予防的な医療です.
- 腫瘍学 腫瘍学
背景:
- 結腸直腸がん (CRC) のスクリーニングは死亡率を低下させていますが,スクリーニング率は最適以下です.
- さまざまなスクリーニング方法があり,専門団体からの推薦も様々です.
- 臨床医は,スクリーニングの順守を保証し,適格な患者のテスト選択を導くという課題に直面しています.
研究 の 目的:
- 様々な結腸直腸がんスクリーニング検査を支持する証拠を批判的に評価する.
- 既定および新興のスクリーニング技術の有効性を評価する.
主な方法:
- PubMedの包括的な文献検索,メタ分析,および参考リスト (1966-2002).
- 健康な個体におけるCRCスクリーニングに関する研究を臨床的結果評価に含める.
- ランダム化対照試験からの証拠の優先順位付け,その後に観察および診断の正確性に関する研究が行われます.
主要な成果:
- 糞便隠蔽血液検査 (FOBT) は,RCTを介してCRCの発生率と死亡率の減少を示した.
- シグモイドスコーピーは,症例対照研究で死亡率の減少を示した; コロノスコピーの有効性は,観察データによって示唆されています.
- FOBTとシグモイドスコーピーの組み合わせは,死亡率の減少と診断の成果を高める可能性があります.
結論:
- 確固たる証拠は,50歳以上の人々に対する常規の結腸直腸がんスクリーニングをサポートしています.
- 現在の証拠は,平均リスクの集団において,スクリーニングテストのいずれかを他のいずれよりも好むわけではない.
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