Nguyen Bich-May, Lin Kenneth W, Mishori Ranit
Memorial Family Medicine Residency Program, 14023 Southwest Freeway, Sugar Land, TX 77478 USA.
2Department of Family Medicine, Georgetown University School of Medicine, 4000 Reservoir Road, N.W, Washington, D.C., 20007 USA.
Public Health Rev. 2018 Jul 2;39:18. doi: 10.1186/s40985-018-0095-6. eCollection 2018.
Overscreening occurs when people without symptoms undergo tests for diseases and the results will not improve their health. In this commentary, we examine three examples of how campaigns to screen and treat specific vascular, metabolic, and oncologic diseases in asymptomatic individuals have produced substantial overdiagnosis and may well have contributed to more harm than good. These conditions were chosen because they may not be as well known as other cases such as screening for breast or prostate cancer.
Screening for carotid artery stenosis can be a lucrative business using portable equipment and mobile vans. While this fatty buildup of plaque in the arteries of the neck is one risk factor for ischemic stroke, current evidence does not suggest that performing carotid dopplers to screen for CAS reduces the incidence of stroke or provide long-term benefits. After a positive screening, the follow-up procedures can lead to heart attacks, bleeding, strokes, and even death. Similarly, many organizations have launched campaigns for "prediabetes awareness." Screening for prediabetes with a blood sugar test does not decrease mortality or cardiovascular events. Identifying people with prediabetes could lead to psychological stress and starting medication that may have significant side effects. Finally, palpating people's necks or examining them with ultrasounds for thyroid cancer is common in many countries but ineffective in reducing mortality. Deadly forms of thyroid cancer are rare, and the overall 5-year survival rate is excellent. Interventions from treatment for more prevalent, less aggressive forms of thyroid cancer can lead to surgical complications, radiation side effects, or require lifelong thyroid replacement therapy.
Screening for carotid artery stenosis, prediabetes, and thyroid cancer in an asymptomatic population can result in unnecessary, harmful, and costly care. Systemic challenges to lowering overscreening include lack of clinician awareness, examination of conflicts of interests, perverse financial incentives, and communication with the general public.
当没有症状的人接受疾病检测且检测结果不会改善其健康状况时，就会出现过度筛查的情况。在本评论中，我们研究了三个例子，说明针对无症状个体筛查和治疗特定血管、代谢和肿瘤疾病的活动如何导致了大量的过度诊断，而且很可能弊大于利。选择这些疾病是因为它们可能不像乳腺癌或前列腺癌筛查等其他情况那样广为人知。
使用便携式设备和移动货车筛查颈动脉狭窄可能是一项利润丰厚的业务。虽然颈部动脉中这种斑块的脂肪堆积是缺血性中风的一个风险因素，但目前的证据并不表明进行颈动脉多普勒检查以筛查颈动脉狭窄能降低中风发病率或带来长期益处。筛查呈阳性后，后续程序可能导致心脏病发作、出血、中风，甚至死亡。同样，许多组织发起了“糖尿病前期认知”活动。用血糖测试筛查糖尿病前期并不能降低死亡率或心血管事件。识别出糖尿病前期患者可能会导致心理压力，并开始使用可能有严重副作用的药物。最后，在许多国家，通过触诊人们的颈部或用超声波检查甲状腺癌很常见，但在降低死亡率方面无效。致命形式的甲状腺癌很少见，总体5年生存率很高。对更常见、侵袭性较小的甲状腺癌形式进行治疗的干预可能会导致手术并发症、放疗副作用，或者需要终身甲状腺替代治疗。
对无症状人群进行颈动脉狭窄、糖尿病前期和甲状腺癌的筛查可能会导致不必要、有害且昂贵的医疗护理。降低过度筛查的系统性挑战包括临床医生缺乏意识、对利益冲突的审查、不正当的经济激励以及与公众的沟通。
