【Stanford大学的研究回顾】对无症状成年人进行疾病的常规筛查有意义吗？

Stanford大学研究回顾所有过去随机对照研究的19种疾病39种筛查，发现筛查几乎都未能降低死亡率，除开腹主动脉瘤的超声筛查，乳腺癌的钼靶，大肠癌的潜血和乙状结肠镜。这与目前的筛查推荐吻合。常规拍胸片，B超，血常规都无意义，这也是为何USPSTF不做这些推荐。

原文链接: http://ije.oxfordjournals.org/content/early/2015/01/14/ije.dyu140.full

Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials

1. Nazmus Saquib¹,
2. Juliann Saquib¹ and
3. John PA Ioannidis¹,²,³,*

• Accepted June 16, 2014.

Abstract

Background: Several popular screening tests, such as mammography and prostate-specific antigen, have met with wide controversy and/or have lost their endorsement recently. We systematically evaluated evidence from randomized controlled trials (RCTs) as to whether screening decreases mortality from diseases where death is a common outcome.

Methods: We searched three sources: United States Preventive Services Task Force (USPSTF), Cochrane Database of Systematic Reviews, and PubMed. We extracted recommendation status, category of evidence and RCT availability on mortality for screening tests for diseases on asymptomatic adults (excluding pregnant women and children) from USPSTF. We identified meta-analyses and individual RCTs on screening and mortality from Cochrane and PubMed.

Results: We selected 19 diseases (39 tests) out of 50 diseases/disorders for which USPSTF provides screening evaluation. Screening is recommended for 6 diseases (12 tests) out of the 19. We assessed 9 non-overlapping meta-analyses and 48 individual trials for these 19 diseases. Among the results of the meta-analyses, reductions where the 95% confidence intervals (CIs) excluded the null occurred for four disease-specific mortality estimates (ultrasound for abdominal aortic aneurysm in men; mammography for breast cancer; fecal occult blood test and flexible sigmoidoscopy for colorectal cancer) and for none of the all-cause mortality estimates. Among individual RCTs, reductions in disease-specific and all-cause mortality where the 95% CIs excluded the null occurred in 30% and 11% of the estimates, respectively.

Conclusions: Among currently available screening tests for diseases where death is a common outcome, reductions in disease-specific mortality are uncommon and reductions in all-cause mortality are very rare or non-existent.

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想要了解USPSTF的常规筛查推荐，请点击:
 

• Colorectal Cancer: Screening, October 2008
  Cancer (Adult, Senior) (2008)
• Prostate Cancer: Screening, May 2012
  Cancer (Adult) (2012)
• Breast Cancer: Screening, November 2009
  Cancer (Adult, Senior) (2009)
• Cervical Cancer: Screening, March 2012
  Cancer (Adolescent, Adult) (2012)
• Lung Cancer: Screening, December 2013
  Cancer (Adult) (2013)

供医生参考的推荐:

http://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care

 

所有跟帖： 

• 这些研究比较可笑。首先，谁来定义“无症状成年人”。医生不查，肯定定义不了。 -pichawxc- ♂ (348 bytes) () 01/20/2015 postreply 13:56:49