マンモグラフィのスクリーニングと公衆衛生政策:視点の必要性
1Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Lancet (London, England)
|July 1, 1995
まとめ
スクリーニング・マンモグラフィは,乳がんによる死亡率の減少にわずかな利点を示しています. 重要な害,偽陽性,そして莫大なコストは,これらのスクリーニングプログラムの公的資金の正当性を疑問視しています.
科学分野:
- 腫瘍学 腫瘍学
- 公衆衛生は公衆衛生である.
- 放射線学 放射線学
背景:
- 早期のマンモグラフィー試験では,50歳以上の女性では乳がんによる死亡率が30%減少することが示唆され,スクリーニングプログラムへの需要を高めました.
- 後の試験では,年齢層にわたる有意な利点が示されず,害とコストに対する公衆の認識は限られている.
- 50歳未満の女性に対するスクリーニングに対するコンセンサスにもかかわらず,高齢女性のための公的資金のプログラムに対する圧力が増大しています.
研究 の 目的:
- マンモグラフィーのスクリーニングの利益,害,費用を批判的に分析する.
- 乳がんスクリーニングプログラムの人口レベルの影響と費用対効果を評価する.
- 公的資金によるマンモグラフィスクリーニングの正当性に関する公衆衛生政策を伝える.
主な方法:
- マンモグラフィーのスクリーニングに関するランダム化制御前向き試験の分析.
- 1年に1人の死亡が少なくなるためにスクリーニングを必要とする女性の数の計算.
- 偽陽性率,偽安心率,および関連するコストの評価.
主要な成果:
- 年間1人余りの命を救うためにスクリーニングが必要な女性の数は,さまざまな試験で大きく (7,086から無限まで) 異なる.
- スクリーニング・マンモグラフィの約5%が陽性または疑わしいもので,80~93%が偽陽性であり,不安と不必要な処置につながります.
- ネガティブなマンモグラフィによる偽りの安心感は,後に乳がんと診断される女性の10〜15%に発生します.
結論:
- 検診用マンモグラフィーの集団的利益は,実質的な害と莫大な費用とともに,限界的です.
- 救われた1人当たりの年間平均コストは,およそ100万~200万ドルのものと見積もられている.
- 年齢を問わず,乳がんのスクリーニングのための公的資金は,利益,害,コストの現在の証拠に基づいて正当化されません.
キーワード:
保健医療と公衆衛生について
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