75岁以上女性乳房扫描查的益处和危害,以告知共享决策:一个模拟建模研究
Jinani Jayasekera1, Sarah Stein2, Oliver W A Wilson3
1Health Equity and Decision Sciences Research Laboratory, National Institute on Minority Health and Health Disparities (NIMHD) Intramural Research Program (IRP), National Institutes of Health, Bethesda, MD, 20892, USA. jinani.jayasekera@nih.gov.
Journal of general internal medicine
|November 27, 2023
概括
对于75岁及以上的女性,持续进行乳房扫描查可以减少乳腺癌死亡率,但会增加错误阳性和过度诊断. 这些信息支持个人查选择的共享决策 (SDM).
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 生物统计学 生物统计学
背景情况:
- 目前的指导方针建议在75岁及以上的女性进行乳房扫描查时进行共享决策 (SDM).
- 个人风险因素和并发症水平影响查决策.
研究的目的:
- 估计75岁,80岁和85岁妇女乳房扫描查的终身益处和危害.
- 通过提供个性化的风险-收益数据,为共享决策 (SDM) 提供信息.
主要方法:
- 使用适应的癌症干预和监测建模网络 (CISNET) 模型进行微模拟建模.
- 查的好处 (癌症检测,避免死亡) 和危害 (错误阳性,过度诊断) 的评估.
- 分析按年龄 (75岁,80岁,85岁),风险因素 (家族病史,乳腺密度) 和并发症水平分层.
主要成果:
- 在75岁时进行一次额外的检查减少了乳腺癌死亡率,但增加了假阳性和过度诊断.
- 在10年内进行的5次额外查显示,死亡人数减少得更为显著,但过度诊断和错误阳性率更高.
- 在年龄较大 (80,85) 和伴随性疾病较高的妇女中进行查,导致避免死亡的数量较少,过度诊断的百分比更高.
结论:
- 在75岁以上的女性中,持续进行乳腺扫描查可以降低乳腺癌的死亡率,但会增加错误阳性和过度诊断.
- 模型输出可以帮助临床医生和患者权衡持续查的好处和危害.
- 个性化风险效益评估对于老年妇女的查决策至关重要.
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