对益处和风险的系统评估,以指导乳腺癌查决策
Lydia E Pace1, Nancy L Keating2
1Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA
|April 3, 2014
概括
乳房扫描查减少了乳腺癌死亡人数,但存在错误阳性和过度诊断等风险. 根据风险和患者偏好个性化查决策最大限度地提高了效益.
科学领域:
- 在瘤学瘤学.
- 放射学 放射学是一门学科.
- 预防医学 预防医学
背景情况:
- 乳腺癌是美国妇女的主要死亡原因.
- 乳房影像查提供了死亡率的好处,但也有潜在的危害.
- 推个性化查决策,特别是对于年轻女性.
研究的目的:
- 审查有关乳房扫描查死亡率益处的证据.
- 总结一下与乳房影像查相关的危害.
- 探索个性化乳房扫描查决策的策略.
主要方法:
- 搜索了MEDLINE (1960-2014) 的好处,危害和决策证据.
- 审查了关键文章,元分析和实践建议.
- 使用美国心脏协会指南评估证据水平.
主要成果:
- 乳房扫描查可以将乳腺癌死亡率降低19%,总体而言.
- 在40-50岁的女性中,超过10年的累积假阳性风险为~61%.
- 过度诊断可能影响~19%的查癌症;净益取决于个体风险.
结论:
- 根据患者的风险概况和偏好,个性化进行乳房扫描查.
- 风险模型和决策辅助工具可以帮助人们做出明智的选择.
- 需要进一步的研究来优化查工具和量化过度诊断.
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