Cole P, Morrison A S
J Natl Cancer Inst. 1980 May;64(5):1263-72.
The value of population screening as an approach to cancer control is controversial because the objectives, benefits, costs, and potential adverse effects of screening programs are not widely agreed upon, nor are the many difficulties involved in evaluating a cancer screening program well recognized. A review of the issues pertinent to cancer screening and their interrelationships is presented. The characteristics of a particular cancer that should be considered before it becomes the target of a screening program are described; emphasis is placed on the prevalence of the detectable preclinical phase. The features of a good screening test are reviewed and the importance of specificity is indicated. Methods for evaluation of screening programs are considered, and the need for measurement of the effects of screening on the mortality rate is emphasized. The biases inherent in some commonly used evaluation procedures, especially lead time bias and length bias, are discussed. The possible adverse effects of cancer screening are pointed out, especially its capacity to increase morbidity. Several approaches to improving cancer screening programs are presented. Finally, the relevance of knowledge regarding the optimum interscreening interval to cancer control and to research issues is described.
作为癌症控制手段的人群筛查的价值存在争议，因为筛查项目的目标、益处、成本和潜在不良影响并未得到广泛认同，而且评估癌症筛查项目所涉及的诸多困难也未得到充分认识。本文对与癌症筛查相关的问题及其相互关系进行了综述。描述了在某种特定癌症成为筛查项目目标之前应考虑的特征；重点强调了可检测临床前期的患病率。回顾了良好筛查试验的特点，并指出了特异性的重要性。考虑了评估筛查项目的方法，并强调了测量筛查对死亡率影响的必要性。讨论了一些常用评估程序中固有的偏差，特别是领先时间偏差和病程长短偏差。指出了癌症筛查可能产生的不良影响，尤其是其增加发病率的可能性。提出了几种改进癌症筛查项目的方法。最后，描述了关于最佳筛查间隔的知识与癌症控制及研究问题的相关性。
