The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Department of Public Health, Bartolins Allé 2, University of Aarhus, Aarhus C, Denmark.
Nat Rev Urol. 2020 Nov;17(11):637-642. doi: 10.1038/s41585-020-0363-3. Epub 2020 Aug 28.
Renal cell carcinoma (RCC) incidence is increasing worldwide. A high proportion of individuals are asymptomatic at diagnosis, but RCC has a high mortality rate. These facts suggest that RCC meets some of the criteria for screening, and a new analysis shows that screening for RCC could potentially be cost-effective. Targeted screening of high-risk individuals is likely to be the most cost-effective strategy to maximize the benefits and reduce the harms of screening. However, the size of the benefit of earlier initiation of treatment and the overall cost-effectiveness of screening remains uncertain. The optimal screening modality and target population is also unclear, and uncertainties exist regarding the specification and implementation of a screening programme. Before moving to a fully powered trial of screening, future work should focus on the following: developing and validating accurate risk prediction models; developing non-invasive methods of early RCC detection; establishing the feasibility, public acceptability and potential uptake of screening; establishing the prevalence of RCC and stage distribution of RCC detected by screening; and evaluating the potential harms of screening, including the impact on quality of life, overdiagnosis and over-treatment.
肾细胞癌（RCC）的发病率在全球范围内呈上升趋势。很大一部分患者在诊断时无症状，但 RCC 的死亡率很高。这些事实表明，RCC 符合部分筛查标准，新的分析表明，RCC 的筛查可能具有成本效益。对高危人群进行有针对性的筛查可能是最大限度地提高筛查效益和减少危害的最具成本效益的策略。然而，早期开始治疗的益处大小以及筛查的总体成本效益仍然不确定。最佳的筛查方式和目标人群也不明确，筛查计划的规范和实施也存在不确定性。在进行全面的筛查试验之前，未来的工作应重点关注以下方面：开发和验证准确的风险预测模型；开发早期 RCC 检测的非侵入性方法；确定筛查的可行性、公众可接受性和潜在参与度；确定筛查发现的 RCC 的患病率和分期分布；以及评估筛查的潜在危害，包括对生活质量的影响、过度诊断和过度治疗。
