查乳房镜和公共卫生政策:需要前景
1Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Lancet (London, England)
|July 1, 1995
概括
查性乳腺扫描显示乳腺癌死亡率降低的益处很小. 严重的危害,错误的阳性和巨大的成本质疑这些查计划的公共资金的合理性.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 放射学 放射学是一门学科.
背景情况:
- 早期的乳房造影试验表明,在50岁以上的女性中,乳腺癌死亡率减少了30%,这推动了对查计划的需求.
- 随后的试验表明,跨年龄组没有显著的益处,公众对危害和成本的认识有限.
- 尽管反对对50岁以下妇女进行查的共识,但对于为老年妇女提供公共资助计划的压力越来越大.
研究的目的:
- 批判性地分析查乳房影像的好处,危害和成本.
- 评估乳腺癌查计划在人口层面的影响和成本效益.
- 为公共卫生政策提供公开资助的乳房镜查的理由的信息.
主要方法:
- 对查性乳房镜像的随机对照前性试验的分析.
- 计算需要查的妇女人数,每年减少一例死亡.
- 对错误的阳性率,错误的保证率和相关成本的评估.
主要成果:
- 每年需要选一个额外的救命的妇女人数在不同的试验中差异很大 (7,086到无限).
- 大约5%的查乳房影像是阳性或可疑的,80-93%是错误的阳性,导致焦虑和不必要的程序.
- 阴性乳房影像的虚假保证发生在10-15%的女性中,这些女性后来被诊断出患有乳腺癌.
结论:
- 查乳房扫描对人口的好处是边际的,带来了大量的伤害和巨大的成本.
- 据估计,平均每人每年的成本约为100万至200万美元.
- 公共资金用于乳腺癌查,不论年龄组,是不合理的基于当前的好处,危害和成本的证据.
关键词:
医疗保健和公共卫生
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