Duffy Michael J
Clinical Research Centre, St Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, 4, Ireland.
Adv Exp Med Biol. 2015;867:27-39. doi: 10.1007/978-94-017-7215-0_3.
Screening for premalignant lesions or early invasive disease has the potential to reduce mortality from cancer. Because of their ease of measurement, several biomarkers have been evaluated or are currently undergoing evaluation as screening tests for early malignancy. These include the use of AFP in screening for hepatocellular cancer in high-risk subjects, CA 125 in combination with transvaginal ultrasound (TVU) in screening for epithelial ovarian cancer, PSA in screening for prostate cancer, faecal occult blood testing (FOBT) in screening for colorectal cancer (CRC) and vanillymandelic acid and homovanillic acid in screening for neuroblastoma in newborn infants, Of these biomarkers, only the use of FOBT in screening for CRC has unequivocally been shown to reduce mortality from cancer. Although 2 large randomized prospective trials have evaluated PSA as a screening test for prostate cancer, it is still unclear whether the benefits outweigh the harms in this setting. Although biomarkers have many attractive features as cancer screening tests, lack of sensitivity and specificity, when combined with the low prevalence of specific cancer types in asymptomatic subjects, limit their application for the early detection of malignancy.
筛查癌前病变或早期浸润性疾病有可能降低癌症死亡率。由于易于测量，几种生物标志物已被评估或正在接受评估，作为早期恶性肿瘤的筛查测试。这些包括在高危人群中使用甲胎蛋白筛查肝细胞癌、联合经阴道超声（TVU）使用CA 125筛查上皮性卵巢癌、使用前列腺特异性抗原筛查前列腺癌、使用粪便潜血试验（FOBT）筛查结直肠癌（CRC）以及使用香草扁桃酸和高香草酸筛查新生儿神经母细胞瘤。在这些生物标志物中，只有使用FOBT筛查CRC已明确显示可降低癌症死亡率。尽管两项大型随机前瞻性试验已评估前列腺特异性抗原作为前列腺癌的筛查测试，但在这种情况下，其益处是否超过危害仍不清楚。尽管生物标志物作为癌症筛查测试有许多吸引人的特点，但缺乏敏感性和特异性，再加上无症状受试者中特定癌症类型的低患病率，限制了它们在早期恶性肿瘤检测中的应用。
