Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King, Campus Box 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
Epidemiol Rev. 2011;33:1-6. doi: 10.1093/epirev/mxr006. Epub 2011 Jun 27.
This volume of Epidemiologic Reviews continues a discussion about screening within the evidence community that has been going on for many years. From various perspectives, the authors of these reviews consider the benefits and harms of screening for multiple conditions; the balance between benefits and harms (and costs) is often not clear. With few exceptions, the contribution of screening to improving the health of the public is small, yet it has become a popular and growing form of prevention. It may be that we are learning that the magnitude of benefit from screening is less than we hoped, and the harms may be greater than we thought. Perhaps we should not think of screening as our primary prevention strategy but rather use screening to make a real, but limited contribution to population health for a few conditions. We might target screening to smaller subpopulations with the highest potential benefit and the lowest potential harm. The payoff for population health could be greater if we shifted some resources we now devote to screening to developing, testing, and implementing alternative approaches to preventing the important threats to population health. There needs to be a wider discussion about these issues with the public.
本卷《流行病学评论》继续讨论了多年来在证据界中关于筛查的问题。这些评论的作者从不同角度考虑了多种疾病筛查的收益和危害；收益和危害（以及成本）之间的平衡往往并不明确。除了少数例外，筛查对改善公众健康的贡献很小，但它已成为一种流行且不断增长的预防形式。也许我们正在了解到，筛查的收益幅度不如我们所期望的那么大，而危害可能比我们想象的更大。也许我们不应该将筛查视为我们的主要预防策略，而应将其用于对少数几种情况的人群健康做出真正但有限的贡献。我们可以将筛查针对具有最高潜在收益和最低潜在危害的更小的亚人群。如果我们将现在用于筛查的一些资源转移到开发、测试和实施预防对人群健康的重要威胁的替代方法上，那么对人群健康的回报可能会更大。需要与公众更广泛地讨论这些问题。
