对不同人群应用统一临床政策的风险：以美国印第安人的乳腺癌为例。
The danger of applying uniform clinical policies across populations: the case of breast cancer in American Indians.
作者信息
Nutting P A, Calonge B N, Iverson D C, Green L A
机构信息
Department of Family Medicine, University of Colorado Health Sciences Center, Denver 80220.
出版信息
Am J Public Health. 1994 Oct;84(10):1631-6. doi: 10.2105/ajph.84.10.1631.
OBJECTIVES
This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates.
METHODS
A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diagnosis, and stage-specific survival. Outcomes included 5-year relative survival, deaths prevented at 5 years, cost per death prevented, and total costs.
RESULTS
The findings suggest that the total cost of breast cancer is 3.6 times higher with the screening mammography program but results in a 27.9% reduction in breast cancer deaths over the first 5 years of the program. Both costs and deaths prevented are sensitive to the incidence of breast cancer in the population and are less favorable in the range of incidence seen in American Indians.
CONCLUSIONS
The cost and impact of a given strategy for cancer screening vary among communities with different disease incidence, stage at diagnosis, and stage-specific survival, as seen in American Indian populations.
目的
本研究探讨了年度乳腺钼靶筛查对不同基线乳腺癌发病率的美国印第安人群的成本和死亡率的影响。
方法
构建决策树，比较年度乳腺钼靶筛查和筛查性临床乳腺检查，并在适当的时候转诊进行诊断性乳腺钼靶检查。构建决策树以检验不同基线癌症发病率、诊断时分期和分期特异性生存率的影响。结果包括5年相对生存率、5年预防的死亡数、预防每例死亡的成本以及总成本。
结果
研究结果表明，乳腺钼靶筛查项目使乳腺癌总成本高出3.6倍，但在该项目的前5年可使乳腺癌死亡人数减少27.9%。预防的成本和死亡数均对人群中乳腺癌的发病率敏感，在美国印第安人所观察到的发病率范围内，效果较差。
结论
正如在美国印第安人群中所看到的那样，对于不同疾病发病率、诊断时分期和分期特异性生存率的社区，特定癌症筛查策略的成本和影响各不相同。
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