欺骗性的癌症早期检测 "成功 "标准

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS
Nicola Cirillo
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引用次数: 0

摘要

癌症的早期检测被认为是预防医学的基石,并被广泛认为是减少癌症死亡的途径。基于这一假设,目前正在进行大型试验,以评估早期检测测试的准确性。因此,当务之急是制定有意义的早期检测 "成功标准",以反映健康结果的真正改善。本文讨论了衡量癌症早期检测试验成功与否的误区,尤其是在筛查项目中,并举例说明常用指标如何具有欺骗性。当诊断出更多早期癌症时,早期检测可能会导致降期(有利的分期转移),即使晚期疾病没有减少,也可能导致过度诊断和过度治疗。生存率统计,主要是癌症特异性生存率,可能会因提前期而产生误导,早期发现只是延长了已知的病程,而不会延长实际寿命或提高总体生存率。此外,比例、比率和百分比等相对指标的滥用往往使人无法确定某项手术的真正益处,并可能扭曲筛查的影响,因为它们受到诊断方法的影响,误导性地提高了预期的死亡率降低率。了解这些偏差对于准确评估癌症检测方法的有效性和确保适当的患者护理至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Deceptive Measures of “Success” in Early Cancer Detection
Early detection of cancer is considered a cornerstone of preventive medicine and is widely perceived as the gateway to reducing cancer deaths. Based on this assumption, large trials are currently underway to evaluate the accuracy of early detection tests. It is imperative, therefore, to set meaningful “success criteria” in early detection that reflect true improvements in health outcomes. This article discusses the pitfalls of measuring the success of early detection tests for cancer, particularly in the context of screening programs, and provides illustrative examples that demonstrate how commonly used metrics can be deceptive. Early detection can result in downstaging (favourable stage shift) when more early-stage cancers are diagnosed, even without reducing late-stage disease, potentially leading to overdiagnosis and overtreatment. Survival statistics, primarily cancer-specific survival, can be misleading due to lead time, where early detection simply extends the known duration of the disease without prolonging actual lifespan or improving overall survival. Additionally, the misuse of relative measures, such as proportions, ratios, and percentages, often make it impossible to ascertain the true benefit of a procedure and can distort the impact of screening as they are influenced by diagnostic practices, misleadingly improving perceived mortality reductions. Understanding these biases is crucial for accurately assessing the effectiveness of cancer detection methods and ensuring appropriate patient care.
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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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