Howard J
Soc Sci Med. 1987;24(6):507-14. doi: 10.1016/0277-9536(87)90340-6.
The National Cancer Institute of the United States is encouraging research aimed at reducing 'avoidable mortality' from cancer. This article explores the meaning of the concept from a cancer-control perspective. Using cervical cancer as the focus of discussion, the author examines reference standards and social constraints that can help define the boundaries of avoidable mortality. The article considers the implications of voluntary participation in screening programs, the negative association between risk status and screening frequency, errors in collecting and interpreting Pap smears, improper and incomplete followup, and selected intervals for screening tests. To reach underscreened populations who are at high risk of cervical cancer, prevention strategists must create opportunities for intervention through innovative 'outreach' and 'inreach' programs. Inreach strategies exploit opportunities for cancer screening within the existing health-care process. Possibilities for reducing mortality from cervical cancer depend on more than the state of science. The likelihood of change is also a function of social priorities, social commitments, and the allocation of resources to social technologies that can effect change.
美国国立癌症研究所正在鼓励开展旨在降低癌症“可避免死亡率”的研究。本文从癌症控制的角度探讨了这一概念的含义。以宫颈癌为讨论重点，作者审视了有助于界定可避免死亡率界限的参考标准和社会制约因素。文章考虑了自愿参与筛查项目的影响、风险状况与筛查频率之间的负相关关系、巴氏涂片采集和解读中的误差、不当及不完整的后续跟进，以及筛查检测的选定间隔时间。为了接触到宫颈癌高危且筛查不足的人群，预防策略制定者必须通过创新的“外展”和“内展”项目创造干预机会。内展策略利用现有医疗保健过程中的癌症筛查机会。降低宫颈癌死亡率的可能性不仅仅取决于科学水平。变化的可能性还取决于社会优先事项、社会承诺以及对能够带来改变的社会技术的资源分配。
