Diaz Abbey, Kang Jimin, Moore Suzanne P, Baade Peter, Langbecker Danette, Condon John R, Valery Patricia C
Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University. PO Box 10639, Brisbane, Qld, 4000, Australia.
School of Medicine, The University of Queensland, 288 Herston Road, Herston Qld 4006, Australia; QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston Qld 4006Australia.
Cancer Epidemiol. 2017 Apr;47:7-19. doi: 10.1016/j.canep.2016.12.010. Epub 2017 Jan 10.
Comorbidity is associated with poor outcomes for cancer patients but it is less clear how it influences cancer prevention and early detection. This review synthesizes evidence from studies that have quantified the association between comorbidity and participation in breast and cervical screening.
PubMed, CINAHL and EMBASE databases were systematically searched using key terms related to cancer screening and comorbidity for original research articles published between 1 January 1991 and 21 March 2016. Two reviewers independently screened 1283 studies that met eligibility criteria related to Population (adult, non-cancer populations), Exposure (comorbidity), Comparison (a 'no comorbidity' group), and Outcome (participation in breast cancer or cervical screening). Data was extracted and risk of bias assessed using a standardised tool from the 22 studies identified for inclusion (17 breast; 13 cervical). Meta-analyses were performed for participation in breast and cervical screening, stratified by important study characteristics.
The majority of studies were conducted in the United States. Results of individual studies were variable. Most had medium to high risk of bias. Based on the three "low risk of bias" studies, mammography screening was less common among those with comorbidity (pooled Odds Ratio 0.66, 95%CI 0.44-0.88). The one "low risk of bias" study of cervical screening reported a negative association between comorbidity and participation.
While a definitive conclusion could not be drawn, the results from high quality studies suggest that women with comorbidity are less likely to participate in breast, and possibly cervical, cancer screening.
合并症与癌症患者的不良预后相关，但合并症如何影响癌症预防和早期检测尚不清楚。本综述综合了量化合并症与乳腺癌和宫颈癌筛查参与之间关联的研究证据。
使用与癌症筛查和合并症相关的关键词，系统检索1991年1月1日至2016年3月21日发表的原始研究文章的PubMed、CINAHL和EMBASE数据库。两名审稿人独立筛选了1283项符合与人群（成人、非癌症人群）、暴露因素（合并症）、对照（“无合并症”组）和结局（参与乳腺癌或宫颈癌筛查）相关的纳入标准的研究。从确定纳入的22项研究（17项乳腺癌研究；13项宫颈癌研究）中提取数据，并使用标准化工具评估偏倚风险。按重要研究特征分层，对参与乳腺癌和宫颈癌筛查进行荟萃分析。
大多数研究在美国进行。个别研究结果各不相同。大多数研究存在中度至高度偏倚风险。基于三项“低偏倚风险”研究，合并症患者中乳腺钼靶筛查的情况较少见（合并比值比0.66，95%置信区间0.44 - 0.88）。一项关于宫颈癌筛查的“低偏倚风险”研究报告了合并症与参与之间的负相关。
虽然无法得出明确结论，但高质量研究的结果表明，合并症女性参与乳腺癌以及可能的宫颈癌筛查的可能性较小。
