主要ケアにおける子宮頸がんのスクリーニング:米国の予防サービスタスクフォースの決定分析
Jane J Kim1, Emily A Burger1,2, Catherine Regan1
1Department of Health Policy and Management, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA
|August 25, 2018
まとめ
5年に一度の高リスクヒトパピローマウイルス (hrHPV) 検査は,子宮頸がんのスクリーニングに良い利益と害のバランスをとります. 30歳の時に細胞検査から hrHPV検査に切り替えると,最も効率的な有害性比が示されました.
科学分野:
- 婦人科
- 腫瘍学
- 公衆衛生
背景:
- 子宮頸がんのスクリーニングに関するガイドラインでは,高リスクヒトパピローマウイルス (hrHPV) 検査の利点と害に関する証拠が必要です.
- 現在のスクリーニングは細胞学に基づいていますが,hrHPV検査は改善の可能性があります.
研究 の 目的:
- 様々な子宮頸がんのスクリーニング戦略の利点と害をモデル化すること.
- 予防サービス・タスクフォースの勧告を参考にすること.
主な方法:
- マイクロシミュレーションモデルでは,仮説的な女性のコホートで19のスクリーニング戦略を評価した.
- 戦略には細胞検査,HRHPV検査,コテスティングが含まれており,年齢の変更,再スクリーニング間隔,トリアージ方法の変動がありました.
- 測定されたアウトカムには,検査,コルポスコピー,疾患検出,偽陽性,がん症例/死亡,および寿命が含まれる.
主要な成果:
- すべてのモデル化戦略は,スクリーニングなしと比較して,子宮頸がんの症例と死亡を著しく減少させた.
- プライマリ hrHPV 検査とコテスティング 戦略は,単一の細胞検査よりもわずかに高い効果を示しましたが,またより大きな害も示しました.
- 5年毎のプライマリ hrHPV検査は有効で,30歳から検査を切り替えると,最も良い有害性比率 (寿命1年あたりのコルポスコピー) が得られた.
結論:
- 5年毎のプライマリーHPVスクリーニングは,有害性と有益性の合理的なバランスを提供するように見えます.
- 30歳の時に細胞検査から hrHPV検査に切り替えることが最も効率的な戦略です
- これらの発見は,最新の子宮頸がんスクリーニングガイドラインを参考にすることができます.
関連する概念動画
01:30Preventive Healthcare Services
2.2K
Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
2.2K
02:59Cancer Prevention
8.1K
Several factors can increase the risk of cancer in an individual. About 50% of cancer cases can be prevented by adopting a healthy lifestyle, regular exercise, eating healthy, and following a modest cancer prevention diet. Epidemiological studies have consistently shown that populations with vegetable and fruit-rich diets have reduced the incidence of cancer. On the other hand, populations who have a diet rich in animal fat, red meat, junk food, or high calories are predisposed to cancer.
Some...
Some...
8.1K
01:30Primary Healthcare Services
2.1K
Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
2.1K
01:20Decision Making
991
Decision-making is a fundamental cognitive process that involves evaluating alternatives and selecting among them. This process can range from simple choices, such as deciding what to wear, to complex decisions, like choosing a major in college or a career path. The complexity of the decision often dictates the approach we use, which can be broadly categorized into two types: automatic and controlled decision-making.
Automatic decision-making is fast, intuitive, and relies on gut feelings...
Automatic decision-making is fast, intuitive, and relies on gut feelings...
991
01:21Cancer Survival Analysis
768
Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
768
01:09Decision Making: P-value Method
7.0K
The process of hypothesis testing based on the P-value method includes calculating the P- value using the sample data and interpreting it.
First, a specific claim about the population parameter is proposed. The claim is based on the research question and is stated in a simple form. Further, an opposing statement to the claim is also stated. These statements can act as null and alternative hypotheses: a null hypothesis would be a neutral statement while the alternative hypothesis can...
First, a specific claim about the population parameter is proposed. The claim is based on the research question and is stated in a simple form. Further, an opposing statement to the claim is also stated. These statements can act as null and alternative hypotheses: a null hypothesis would be a neutral statement while the alternative hypothesis can...
7.0K