Armstrong Katrina, Kim Jane J, Halm Ethan A, Ballard Rachel M, Schnall Mitchell D
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
Cancer. 2016 May 1;122(9):1338-42. doi: 10.1002/cncr.29937. Epub 2016 Feb 29.
Multiple advisory groups now recommend that high-risk smokers be screened for lung cancer by low-dose computed tomography. Given that the development of lung cancer screening programs will face many of the same issues that have challenged other cancer screening programs, the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium was used to identify lessons learned from the implementation of breast, cervical, and colorectal cancer screening that should inform the introduction of lung cancer screening. These lessons include the importance of developing systems for identifying and recruiting eligible individuals in primary care, ensuring that screening centers are qualified and performance is monitored, creating clear communication standards for reporting screening results to referring physicians and patients, ensuring follow-up is available for individuals with abnormal test results, avoiding overscreening, remembering primary prevention, and leveraging advances in cancer genetics and immunology. Overall, this experience emphasizes that effective cancer screening is a multistep activity that requires robust strategies to initiate, report, follow up, and track each step as well as a dynamic and ongoing oversight process to revise current screening practices as new evidence regarding screening is created, new screening technologies are developed, new biological markers are identified, and new approaches to health care delivery are disseminated. Cancer 2016;122:1338-1342. © 2016 American Cancer Society.
多个咨询小组目前建议，对高危吸烟者进行低剂量计算机断层扫描以筛查肺癌。鉴于肺癌筛查项目的开展将面临许多与其他癌症筛查项目相同的挑战，由美国国立癌症研究所资助的基于人群的个性化筛查方案优化研究（PROSPR）联盟被用来总结从乳腺癌、宫颈癌和结直肠癌筛查实施过程中吸取的经验教训，这些经验教训应能为肺癌筛查的引入提供参考。这些经验教训包括：建立在初级保健中识别和招募符合条件个体的系统的重要性；确保筛查中心具备资质并对其绩效进行监测；制定向转诊医生和患者报告筛查结果的明确沟通标准；确保为检测结果异常的个体提供后续跟进；避免过度筛查；牢记一级预防；以及利用癌症遗传学和免疫学方面的进展。总体而言，这一经验强调，有效的癌症筛查是一项多步骤活动，需要强有力的策略来启动、报告、跟进和跟踪每一步骤，以及一个动态且持续的监督过程，以便随着有关筛查的新证据产生、新筛查技术开发、新生物标志物识别以及新的医疗服务提供方式传播，对当前的筛查实践进行修订。《癌症》2016年；122:1338 - 1342。© 2016美国癌症协会。
