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There’s almost no evidence that cancer screening saveslives, say researchers
A misunderstanding of mortality rates has led to false optimism.
file:///C:/Users/lenovo/AppData/Local/Temp/msohtmlclip1/01/clip_image002.jpg This is just as awkward as itlooks.
In a bracing op-ed published yesterday in the British MedicalJournal, researchers questioned the ideathat cancer screening "saves lives" as many PSAs for theseservices promise. Cancer researcher Vinay Prasad and his colleagues warn thatcancer screening has "never been shown" to affect general mortalityrates, arguing that patients are being over-screened and often misdiagnosed. 在“英国医学杂志”昨日刊登的一则振奋人心的专栏中，研究人员对许多公益性广告所承诺的癌症筛检能够挽救生命这一观点提出了质疑。癌症研究员Vinay Prasad及其同事警示道：癌症筛检“从未被证实”会对整体死亡率造成影响。并称病人现在正在被过度筛检和误诊。
The problem they highlight is a common one in themedical field: statistics on how cancer screeningaffects mortality rates have been widely misunderstood and misreported. Prasadand his colleagues explain that studies show cancer screening can lowermortality rates for people who already have specific diseases suchas lung cancer, but the general mortality rate has remainedunchanged since the advent of common tests for breast cancer, colon cancer,neuroblastoma, and prostate cancer. In other words, screeningmay be slightly improving mortality rates for people who havea disease, but screening is not improving mortality overall. As theresearchers put it in their op-ed, people are "simply...trading one typeof death for another." More simply: even if you're screenedfor cancer, your risk of dying every year remains the same. 他们强调的问题在医疗领域早已司空见惯：有关癌症筛检如何影响死亡率的数据被大范围地误解和误报。Prasad和他的同事解释道：对于那些已经患有明确疾病（例如肺癌）的患者来说，癌症筛检的确能够降低死亡率；但自乳腺癌、结肠癌、成神经细胞肿瘤以及前列腺癌的常规测试方法问世以来，总死亡率仍保持不变。换而言之，筛检或许会稍微改善患有特定疾病的患者的死亡率，但对整体的死亡率并没有任何改善。正如研究人员在他们专栏文章里所说，人们“只不过是从一种死亡方式换到了另一种而已。”更通俗易懂地说，即使做了癌症筛检，你每年的死亡风险并没有任何变化。
This wouldn't be cause for concern if itweren't for the fact that cancer screening is expensive for both patients andthe healthcare industry. On top of that, screening can itself cause healthproblems. False positives, which are common, can lead to extreme anxiety,unnecessary treatments, and even death. 如果不是因为癌症筛检的费用对患者和医疗行业来说都十分昂贵，这个问题也不会引起关注。最重要的是，筛检本身也会引发健康问题。最常见的假阳性化验结果会导致极度的焦虑，不必要的治疗，甚至会导致死亡。
This is particularly obvious when it comes toprostate screening, as the researchers explain: 这一点在前列腺癌筛检中尤其明显，研究人员解释道：
For example, prostate specific antigen (PSA)testing yields numerous false positive results, which contribute to over onemillion prostate biopsies a year. Prostate biopsies are associated withserious harms, including admission to hospital and death. Moreover, mendiagnosed with prostate cancer are more likely to have a heart attack or commitsuicide in the year after diagnosis or to die of complications oftreatment for cancers that may never have caused symptoms. 举个例子，前列腺特异抗原检测会产生许多假阳性结果，这也导致一年中超过一百万人进行前列腺穿刺。前列腺穿刺会给患者身体带来严重的损伤，包括住院治疗以及死亡。此外，被诊断患有前列腺癌的男性更容易心脏病发作或是在一年内自杀，抑或是死于无病征的癌症治疗并发症。
The group continues, noting another issue isthat cancer screening gives patients a false picture of their health outcomes: 研究小组继续谈了另一个问题，便是癌症筛检会使患者对他们的健康状况产生一个错误的认识：
In one study 68 percent of women thought thatmammography would lower their risk of getting breast cancer, 62 percent thoughtthat screening at least halved the rate of breast cancer, and 75 percentthought that 10 years of screening would prevent 10 breast cancer deaths per1000 women. Even the most optimistic estimates of screening do notapproach these numbers. 在一项研究中，68%的女性认为乳房X光检查能够降低她们患乳腺癌的风险，62%的女性认为筛检至少降低了患乳腺癌一半的风险，而且75%的女性认为至少可以防止在每1000名女性中10个因乳腺癌而死亡的病例。即使是对筛检结果最乐观的估计也并没有达到以上这些数据标准。
What's the solution? In some countries likeSwitzerland, the national medical board has stopped recommending annualmammograms. In the US, the standard of care for cervical cancer screenings hasgone from yearly tests to bi-annual or even longer. Prasad and his colleaguessay cancer screenings can be helpful, but only when a patient's specifichistory seems to call for it. These tests shouldn't be given by default butinstead only after a doctor has discussed the pros and cons withpatients—making it clear that screening may not be an effective way toreduce risk. 那么解决的办法是什么呢？在一些国家例如瑞士，国家医学委员会已经停止推荐每年一次的乳房X光检查。在美国，宫颈癌筛检的护理标准已经由原先每年一次的检测变为两年一次或者更久。Prasad及其同事表示癌症筛检的确是有帮助的，但仅仅只有在某个患者详细的病史表明他/她的确需要的情况下才能有所帮助。这些测试不应该默认状态下分配各每个人，而需要在医生已经同患者讨论过筛检的利弊，并确保他们已经清楚筛检并不是减少癌症风险的有效方式之后才能进行。
Eliminating unnecessary cancer screening, accordingto the researchers, might free up money to do a serious statisticalanalysis of how cancer screening affects general mortality rate. Such ananalysis would require millions of participants, but it would still be cheaperthan administering millions of cancer screenings. The researchers also suggestthat the medical community should focus on coming up with "novel prostatescreening strategies" that are more accurate. 如果取消这些不必要的癌症筛检，根据研究人员的说法，可能会有多余的资金对癌症筛检的数据进行一个详细严谨分析，分析其对整体死亡率会造成什么影响。这样一个分析将会需要数以万计的参与者，但仍比进行数以万计的癌症筛选要划算很多。研究人员还建议医学界应该集中注意力去想出更为精确的“前列腺筛检的创新策略方案”。
To be clear, the op-ed does not suggest thatyou should cancel all your cancer screening tests this year. Instead, itcautions people to be realistic about these screenings because they do notappear to reduce general mortality rates. Most importantly, patientsshould talk with their doctors about whether such tests are absolutelynecessary instead of undergoing them out of an unfounded belief that they"save lives." 在此需要明确的是，这篇专栏并不是建议你取消掉今年你所有的癌症筛检测试。而是提醒人们对这些筛检保持一个现实的态度，因为它们似乎并不会降低整体死亡率。最重要的是，患者应该同他们的医生交流以确定这样的测试是否必不可少，而不应该本着它们能“救命”这样一个毫无根据的信念去做这些测试。
英国医学杂志 2015. 数字对象唯一标示符：10.1136/bmj.h6080 翻译仅供学习交流，严禁用于商业用途 PDF文档下载；
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发表于 2016-6-30 16:29:45
