Department of Health Policy and Management, Emory University, Atlanta, GA (DHH, YLH)
Med Decis Making. 2012 Jul-Aug;32(4):627-35. doi: 10.1177/0272989X11434600. Epub 2012 Jan 27.
Recently revised US Preventive Services Task Force screening guidelines for colorectal, breast, and prostate cancer contain separate recommendations for persons younger than 75 years and those 75 years or older. Developing an understanding of whether and how patients discontinue screening is important for evaluating the potential benefits and drawbacks of age-delimited screening recommendations as a tool for reducing overdiagnosis rates. Using Surveillance, Epidemiology, and End
-Medicare data from 1998 to 2007, the authors identified a sample of 32,189 female and 27,669 male fee-for-service Medicare beneficiaries who received 2 consecutive breast or prostate screens, 1 year apart. They then estimated the impact of serious health events, such as heart attacks and strokes, on continuation of screening. Rescreening rates among beneficiaries who did not experience a serious health event were 78% for women and 82% for men. Rescreening rates among beneficiaries who experienced a serious health event were 55% for women and 57% for men. The rate ratios associated with a time-varying indicator for the 2-year period following a serious health event were 0.79 (95% confidence interval: 0.76 to 0.81); P < 0.001) for women and 0.87 (95% confidence interval: 0.85 to 0.89; P < 0.001) for men. Approximately one-third of patients and physicians discontinue or temporarily suspend screening for breast and prostate cancer following serious health events. Findings suggest that not all patients persist with screening until they die.
最近修订的美国预防服务工作组（USPSTF）的结直肠癌、乳腺癌和前列腺癌筛查指南，为年龄在 75 岁以下和 75 岁及以上的人群提供了单独的建议。了解患者是否以及如何停止筛查，对于评估年龄限制筛查建议作为降低过度诊断率的工具的潜在益处和弊端非常重要。本研究利用监测、流行病学和最终结果（SEER）-医疗保险数据库，评估了严重健康事件（如心脏病发作和中风）对连续筛查的影响。
研究人员使用 1998 年至 2007 年的监测、流行病学和最终结果-医疗保险数据，确定了一个连续接受 2 次乳房或前列腺筛查、间隔 1 年的女性样本 32189 例，男性样本 27669 例。然后，他们估计了严重健康事件（如心脏病发作和中风）对继续筛查的影响。在未发生严重健康事件的受益人群中，重新筛查率为女性 78%，男性 82%。在发生严重健康事件的受益人群中，重新筛查率为女性 55%，男性 57%。与严重健康事件后 2 年时间变化指标相关的率比为 0.79（95%置信区间：0.76 至 0.81）；P<0.001），女性为 0.87（95%置信区间：0.85 至 0.89；P<0.001）。大约三分之一的患者和医生在发生严重健康事件后会停止或暂时暂停对乳腺癌和前列腺癌的筛查。研究结果表明，并非所有患者都会坚持筛查直至死亡。
