无症状成年人的疾病筛查能否拯救生命？荟萃分析和随机试验的系统评价。
Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials.
机构信息
Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA.
Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
出版信息
Int J Epidemiol. 2015 Feb;44(1):264-77. doi: 10.1093/ije/dyu140. Epub 2015 Jan 15.
BACKGROUND
Several popular screening tests, such as mammography and prostate-specific antigen, have met with wide controversy and/or have lost their endorsement recently. We systematically evaluated evidence from randomized controlled trials (RCTs) as to whether screening decreases mortality from diseases where death is a common outcome.
METHODS
We searched three sources: United States Preventive Services Task Force (USPSTF), Cochrane Database of Systematic Reviews, and PubMed. We extracted recommendation status, category of evidence and RCT availability on mortality for screening tests for diseases on asymptomatic adults (excluding pregnant women and children) from USPSTF. We identified meta-analyses and individual RCTs on screening and mortality from Cochrane and PubMed.
RESULTS
We selected 19 diseases (39 tests) out of 50 diseases/disorders for which USPSTF provides screening evaluation. Screening is recommended for 6 diseases (12 tests) out of the 19. We assessed 9 non-overlapping meta-analyses and 48 individual trials for these 19 diseases. Among the results of the meta-analyses, reductions where the 95% confidence intervals (CIs) excluded the null occurred for four disease-specific mortality estimates (ultrasound for abdominal aortic aneurysm in men; mammography for breast cancer; fecal occult blood test and flexible sigmoidoscopy for colorectal cancer) and for none of the all-cause mortality estimates. Among individual RCTs, reductions in disease-specific and all-cause mortality where the 95% CIs excluded the null occurred in 30% and 11% of the estimates, respectively.
CONCLUSIONS
Among currently available screening tests for diseases where death is a common outcome, reductions in disease-specific mortality are uncommon and reductions in all-cause mortality are very rare or non-existent.
背景
几种流行的筛查测试，如乳房 X 光检查和前列腺特异性抗原检查，最近受到了广泛的争议和/或失去了认可。我们系统地评估了来自随机对照试验（RCT）的证据，以确定筛查是否能降低常见死因疾病的死亡率。
方法
我们从三个来源进行了搜索：美国预防服务工作组（USPSTF）、考科兰协作数据库的系统评价和 PubMed。我们从 USPSTF 中提取了针对无症状成年人（不包括孕妇和儿童）的疾病筛查测试的推荐状态、证据类别和 RCT 死亡率数据。我们从 Cochrane 和 PubMed 中确定了有关筛查和死亡率的荟萃分析和个体 RCT。
结果
我们从 USPSTF 提供的 50 种疾病/病症中选择了 19 种疾病（39 项测试）。在这 19 种疾病中，有 6 种疾病（12 项测试）被推荐进行筛查。我们对这 19 种疾病的 9 项非重叠荟萃分析和 48 项个体试验进行了评估。在荟萃分析的结果中，有四项疾病特异性死亡率估计值（男性腹主动脉瘤的超声检查、乳腺癌的乳房 X 光检查、结直肠癌的粪便潜血试验和乙状结肠镜检查）的 95%置信区间（CI）排除了无效值，而所有原因死亡率估计值则没有一项排除无效值。在个体 RCT 中，有 30%和 11%的疾病特异性和全因死亡率估计值的 95%CI 排除了无效值，死亡率有所降低。
结论
在目前可用于常见死因疾病的筛查测试中，疾病特异性死亡率降低的情况并不常见，全因死亡率降低的情况则非常罕见或不存在。
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