Ahlquist David A
Mayo Clinic, Rochester, MN USA.
NPJ Precis Oncol. 2018 Oct 29;2:23. doi: 10.1038/s41698-018-0066-x. eCollection 2018.
Cancer remains the second leading cause of mortality worldwide, and overall cancer-related deaths are increasing. Despite the survival benefit from early detection, screening has to date targeted only those few organs that harbor tumors of sufficient prevalence to show cost-effectiveness at population levels, leaving most cancer types unscreened. In this perspective overview, a case is made for universal cancer screening as a logical and more inclusive approach with potentially high impact. The centrally important conceptual drivers to universal screening are biological and epidemiological. The shared biology of tumor marker release into a common distant medium, like blood, can be exploited for multi-cancer detection from a single test. And, by aggregating prevalence rates, universal screening allows all cancers (including less common ones) to be included as targets, increases screening efficiency and integration across tumor types, and potentially improves cost-effectiveness over single-organ approaches. The identification of new tumor marker classes with both broad expression across tumor types and site-prediction, remarkable advances in assay technologies, and compelling early clinical data increase the likelihood of actualizing this new paradigm. Multi-organ screening could be achieved by targeting markers within or stemming from the circulation (including blood, urine, saliva, and expired breath) or those exfoliated into common excretory pathways (including the gastrointestinal and female reproductive tracts). Rigorous clinical studies in intended use populations and collaborations between academia, industry, professional societies, and government will be required to bring this lofty vision to a population application.
癌症仍然是全球第二大死因，且与癌症相关的总体死亡人数正在增加。尽管早期检测能带来生存益处，但迄今为止，筛查仅针对少数几个器官，这些器官中肿瘤的患病率足以在人群层面显示出成本效益，而大多数癌症类型仍未得到筛查。在这篇观点综述中，我们提出将通用癌症筛查作为一种合理且更具包容性、可能具有重大影响的方法。通用筛查的核心重要概念驱动因素是生物学和流行病学因素。肿瘤标志物释放到血液等共同的远处介质中的共同生物学特性，可用于通过单次检测进行多种癌症的检测。而且，通过汇总患病率，通用筛查可将所有癌症（包括不太常见的癌症）纳入目标范围，提高筛查效率以及跨肿瘤类型的整合度，并有可能比单一器官筛查方法提高成本效益。新型肿瘤标志物类别的识别，这些标志物在多种肿瘤类型中广泛表达且具有部位预测能力，检测技术的显著进步，以及引人注目的早期临床数据，增加了实现这一新模式的可能性。多器官筛查可以通过针对循环系统（包括血液、尿液、唾液和呼出气体）中或源自循环系统的标志物，或那些脱落到常见排泄途径（包括胃肠道和女性生殖道）中的标志物来实现。需要在目标使用人群中进行严格的临床研究，以及学术界、产业界、专业协会和政府之间的合作，才能将这一宏伟愿景应用于人群。
