結腸直腸がんスクリーニング:臨床応用
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
結腸直腸がんのスクリーニングは,50歳以上の成人の死亡率を大幅に低下させます. 利用可能な検査にもかかわらず,患者と医師の障壁のためにスクリーニング率は低い. 遵守を改善するための戦略が議論されます.
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.
- 公衆衛生は公衆衛生である.
背景:
- 結腸直腸がんのスクリーニングは,50歳以上の人間の死亡率を低下させます.
- 推奨されるスクリーニング検査には,糞便のオカルト血液検査,シグモイドスコーピー,二重コントラストバリウム浸水,大腸内視鏡などがあります.
- 推奨にもかかわらず,結腸直腸がんのスクリーニング率は低いままです.
研究 の 目的:
- 様々な結腸直腸がんスクリーニング検査の証拠の質に関する問題に対処するために.
- 高リスクの個人,テストの可用性,および費用対効果に対する修正を評価する.
- 結腸直腸がんのスクリーニングに対する患者および医師の障壁を特定し,従順性を高めるための戦略を提案する.
主な方法:
- 結腸直腸がんのスクリーニングに関する現在の専門組織の推奨事項のレビュー.
- 異なるスクリーニング方法の証拠品質の分析.
- スクリーニング遵守の障壁を特定し,議論する.
- スクリーニングの遵守を強化するための戦略の提案.
主要な成果:
- 複数のスクリーニングテストが利用可能で推奨されていますが,その証拠の質は異なります.
- 患者に関連する要因と医師に関連する要因は,スクリーニングに重大な障壁を提示します.
- 費用対効果と利用可能性は,広範な採用のための重要な考慮事項です.
結論:
- 結腸直腸がんのスクリーニング率を改善するには,患者と医師が特定した障壁に対処する必要があります.
- 証拠の質,リスクの階層化,利用可能性,および費用対効果を考慮する必要があります.
- ターゲットを絞った戦略の実施は,遵守率を高め,結腸直腸がんによる死亡率を低減するために極めて重要です.
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