Black W C
Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Eff Clin Pract. 1999 Mar-Apr;2(2):86-95.
Advances in imaging technology have provided numerous opportunities for cancer screening but have also raised numerous questions.
Who should be screened and how exactly should screening be performed?
If spiral computed tomography (spiral CT) were being considered for lung cancer screening, for example, important questions would need to be answered: Should nonsmokers be screened? How often should screening take place? What should the diagnostic work-up be after abnormal findings were seen on spiral CT?
Randomized, controlled trials (RCTs) are the most valid method for determining which medical interventions are most effective. These trials are particularly useful in the evaluation of screening because they eliminate the early detection biases that may result in groosly misleading survival statistics.
Randomized, controlled trials of screening are subject to other biases, and their results may be difficult to generalize. In addition, because they require an enormous number of participants and many years of follow-up, RCTs can be applied only to a small proportion of the questions about cancer screening.
Quantitative decision analysis can be applied to the remaining questions and help inform decision making about cancer screening.
成像技术的进步为癌症筛查提供了众多机会，但也引发了诸多问题。
谁应该接受筛查，以及具体应如何进行筛查？
例如，如果考虑使用螺旋计算机断层扫描（螺旋CT）进行肺癌筛查，就需要回答一些重要问题：非吸烟者应该接受筛查吗？筛查应该多久进行一次？在螺旋CT上发现异常后，诊断检查应该怎么做？
随机对照试验（RCT）是确定哪种医疗干预最有效的最有效方法。这些试验在筛查评估中特别有用，因为它们消除了可能导致严重误导生存统计数据的早期检测偏差。
筛查的随机对照试验容易受到其他偏差的影响，其结果可能难以推广。此外，由于它们需要大量参与者和多年随访，随机对照试验只能应用于一小部分关于癌症筛查的问题。
定量决策分析可应用于其余问题，并有助于为癌症筛查的决策提供信息。
