Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E 63rd St, Second Floor, New York, NY 10065, USA.
JAMA. 2010 Oct 13;304(14):1584-91. doi: 10.1001/jama.2010.1449.
Cancer screening has been integrated into routine primary care but does not benefit patients with limited life expectancy.
To evaluate the extent to which patients with advanced cancer continue to be screened for new cancers.
DESIGN, SETTING, AND PARTICIPANTS: Utilization of cancer screening procedures (mammography, Papanicolaou test, prostate-specific antigen [PSA], and lower gastrointestinal [GI] endoscopy) was assessed in 87,736 fee-for-service Medicare enrollees aged 65 years or older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005, and reported to one of the Surveillance, Epidemiology, and End Results (SEER) tumor registries. Participants were followed up until death or December 31, 2007, whichever came first. A group of 87,307 Medicare enrollees without cancer were individually matched by age, sex, race, and SEER registry to patients with cancer and observed over the same period to evaluate screening rates in context. Demographic and clinical characteristics associated with screening were also investigated.
For each cancer screening test, utilization rates were defined as the percentage of patients who were screened following the diagnosis of an incurable cancer.
Among women following advanced cancer diagnosis compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%-9.1%) vs 22.0% (95% CI, 21.7%-22.5%); Papanicolaou test screening was received by 5.8% (95% CI, 5.6%-6.1%) vs 12.5% (95% CI, 12.2%-12.8%). Among men following advanced cancer diagnosis compared with controls, PSA test was received by 15.0% (95% CI, 14.7%-15.3%) vs 27.2% (95% CI, 26.8%-27.6%). For all patients following advanced diagnosis compared with controls, lower GI endoscopy was received by 1.7% (95% CI, 1.6%-1.8%) vs 4.7% (95% CI, 4.6%-4.9%). Screening was more frequent among patients with a recent history of screening (16.2% [95% CI, 15.4%-16.9%] of these patients had mammography, 14.7% [95% CI, 13.7%-15.6%] had a Papanicolaou test, 23.3% [95% CI, 22.6%-24.0%] had a PSA test, and 6.1% [95% CI, 5.2%-7.0%] had lower GI endoscopy).
A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.
癌症筛查已纳入常规初级保健，但对预期寿命有限的患者没有益处。
评估晚期癌症患者继续接受新癌症筛查的程度。
设计、地点和参与者：在 1998 年至 2005 年间，对被诊断为晚期肺癌、结直肠癌、胰腺癌、胃食管或乳腺癌且向其中一个监测、流行病学和结果 (SEER) 肿瘤登记处报告的 87736 名年龄在 65 岁或以上的自费医疗保险参保者，评估癌症筛查程序（乳房 X 线照相术、巴氏试验、前列腺特异性抗原 [PSA] 和下胃肠道 [GI] 内镜检查）的使用情况。参与者在死亡或 2007 年 12 月 31 日之前首先接受随访，以先到者为准。一组 87307 名无癌症的医疗保险参保者按年龄、性别、种族和 SEER 登记处与癌症患者进行一对一匹配，并在同一时期进行观察，以评估背景下的筛查率。还研究了与筛查相关的人口统计学和临床特征。
对于每项癌症筛查测试，使用率定义为在诊断出不可治愈的癌症后接受筛查的患者百分比。
与对照组相比，女性在接受晚期癌症诊断后，至少接受一次乳房 X 线筛查的比例为 8.9%（95%置信区间 [CI]，8.6%-9.1%）；接受巴氏试验筛查的比例为 5.8%（95% CI，5.6%-6.1%）。与对照组相比，男性在接受晚期癌症诊断后，接受 PSA 测试的比例为 15.0%（95% CI，14.7%-15.3%）；接受 PSA 测试的比例为 27.2%（95% CI，26.8%-27.6%）。与对照组相比，所有接受晚期诊断的患者中，接受下胃肠道内镜检查的比例为 1.7%（95% CI，1.6%-1.8%）；接受下胃肠道内镜检查的比例为 4.7%（95% CI，4.6%-4.9%）。在最近有过筛查史的患者中，筛查更为常见（16.2%[95% CI，15.4%-16.9%]的患者接受乳房 X 线照相术，14.7%[95% CI，13.7%-15.6%]接受巴氏试验，23.3%[95% CI，22.6%-24.0%]接受 PSA 测试，6.1%[95% CI，5.2%-7.0%]接受下胃肠道内镜检查）。
相当一部分晚期癌症患者仍在接受不太可能带来明显获益的癌症筛查测试。
