Hankey B F, Feuer E J, Clegg L X, Hayes R B, Legler J M, Prorok P C, Ries L A, Merrill R M, Kaplan R S
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA.
J Natl Cancer Inst. 1999 Jun 16;91(12):1017-24. doi: 10.1093/jnci/91.12.1017.
The prostate-specific antigen test was approved by the U.S. Food and Drug Administration in 1986 to monitor the disease status in patients with prostate cancer and, in 1994, to aid in prostate cancer detection. However, after 1986, the test was performed on many men who had not been previously diagnosed with prostate cancer, apparently resulting in the diagnosis of a substantial number of early tumors. Our purpose is to provide insight into the effect of screening on prostate cancer rates. Detailed data are presented for whites because the size of the population allows for calculating statistically reliable rates; however, similar overall trends are seen for African-Americans and other races.
Prostate cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and mortality data from the National Center for Health Statistics were analyzed.
RESULTS/CONCLUSIONS: The following findings are consistent with a screening effect: 1) the recent decrease since 1991 in the incidence of distant stage disease, after not having been perturbed by screening; 2) the decline in the incidence of earlier stage disease beginning the following year (i.e., 1992); 3) the recent increases and decreases in prostate cancer incidence and mortality by age that appear to indicate a calendar period effect; and 4) trends in the incidence of distant stage disease by tumor grade and trends in the survival of patients with distant stage disease by calendar year that provide suggestive evidence of the tendency of screening to detect slower growing tumors.
The decline in the incidence of distant stage disease holds the promise that testing for prostate-specific antigen may lead to a sustained decline in prostate cancer mortality. However, population data are complex, and it is difficult to confidently attribute relatively small changes in mortality to any one cause.
前列腺特异性抗原检测于1986年获得美国食品药品监督管理局批准，用于监测前列腺癌患者的疾病状态，并于1994年辅助前列腺癌检测。然而，1986年后，该检测应用于许多此前未被诊断出前列腺癌的男性，显然导致了大量早期肿瘤的诊断。我们的目的是深入了解筛查对前列腺癌发病率的影响。由于白人人口规模允许计算出统计上可靠的发病率，因此给出了白人的详细数据；然而，非裔美国人和其他种族也呈现出类似的总体趋势。
分析了美国国家癌症研究所监测、流行病学和最终结果计划中的前列腺癌发病率数据以及美国国家卫生统计中心的死亡率数据。
结果/结论：以下发现与筛查效果一致：1）1991年以来，远处转移期疾病的发病率在未受筛查干扰后近期有所下降；2）次年（即1992年）开始早期疾病的发病率下降；3）前列腺癌发病率和死亡率近期按年龄的增减似乎表明存在日历期效应；4）远处转移期疾病发病率按肿瘤分级的趋势以及远处转移期疾病患者按历年的生存趋势提供了提示性证据，表明筛查倾向于检测生长较慢的肿瘤。
远处转移期疾病发病率的下降预示着前列腺特异性抗原检测可能会导致前列腺癌死亡率持续下降。然而，人群数据复杂，很难自信地将死亡率相对较小的变化归因于任何单一原因。
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