Austoker J
Department of Public Health and Primary Care, University of Oxford.
BMJ. 1994 Jul 30;309(6950):315-20. doi: 10.1136/bmj.309.6950.315.
Screening for cancer should not be offered routinely to a symptomatic people on a population basis unless it has been shown to be effective in reducing mortality in randomised controlled trials. A suitable screening test should have high sensitivity and specificity and a high positive predictive value. There is an ethical imperative to ensure that the benefit to each person from screening is likely to outweight the possible harm. Preliminary studies have identified suitable screening tests for ovarian cancer, and a randomised controlled trail is about to start. There is considerable controversy about whether to screen for prostatic cancer. Likewise, there is uncertainty about the best means of treating localised prostatic cancer. Screening for prostatic cancer raises important ethical considerations which should not be ignored. Testicular self examination is of unproved benefit. Although there is a need for education about the early signs and symptoms of testicular cancer to reduce delay at presentation, a case cannot be made for screening.
除非在随机对照试验中已证明其对降低死亡率有效，否则不应在人群基础上对有症状的人群常规进行癌症筛查。合适的筛查试验应具有高灵敏度、高特异性和高阳性预测值。确保筛查给每个人带来的益处可能超过潜在危害，这在伦理上是必要的。初步研究已确定了适合卵巢癌的筛查试验，一项随机对照试验即将启动。对于是否进行前列腺癌筛查存在相当大的争议。同样，对于治疗局限性前列腺癌的最佳方法也存在不确定性。前列腺癌筛查引发了重要的伦理考量，不容忽视。睾丸自我检查的益处尚未得到证实。尽管需要开展关于睾丸癌早期体征和症状的教育以减少就诊延迟，但尚无理由进行筛查。
