This article is from WeChat public account: Back to Park (fanpu2019) , author: He Xiaosong, Photo by Drew Hays on Unsplash
Key points
1 Colorectal and cervical cancer-screening is highly recommended
2 Thyroid cancer-against screening
3 Screening for prostate cancer-proceed with caution
4 breast cancer screening-recommended, but urgently needed to improve
In China, the United States and many other countries, cancer is the second leading cause of death, second only to cardiovascular and cerebrovascular diseases. Many authoritative voices have warned: The key to dealing with malignant tumors that make people talk about discoloration is the word “early”. To be detected, diagnosed and treated early, it is best to detect sprouting cancerous tumors before symptoms appear Annihilate it.
But is this strategy applicable to all cancers?
In 1984, the US Department of Health formed a National Preventive Services Task Force (USPSTF) [1 ] , consisting of 16 first-rate disease prevention experts and epidemiologists as volunteers, serving every four years. The mission of the USPSTF is to systematically and comprehensively review the available scientific evidence and independently issue guidance on preventive measures for various diseases for clinicians and the public. The USPSTF will also make the necessary amendments and updates to the recommendations in a timely manner based on the latest clinical research results and various comments.
In studying various preventive measures, the USPSTF only considersThe benefits and risks brought by are completely independent of the cost. The recommended precautionary measures, no matter how expensive they are, must be paid by the American medical insurance company as required by the government and not passed on to patients. A very important part of the various recommendations it issues are the principles and specific methods of early screening before various clinical symptoms of cancer appear.
USPSTF screens each cancer into five categories, A, B, C, D, and I, based on the reliability of the available evidence and the magnitude of the net benefits of the screening measures. Types A and B are recommended screenings, of which Type A is sufficient evidence that the screening has a significant net benefit, and Type B is sufficient evidence that the screening has a moderate net benefit, or moderate The evidence suggests that screening has moderate to significant net benefits. Screening classified as Category C has moderate or more evidence that the screening has a small net benefit. The decision should be made based on the actual situation of each patient and the professional judgment of the doctor. Class D is a screening program that the USPSTF opposes. Class I indicates that the available evidence is insufficient to make an accurate assessment of the benefits and harms of screening.
As of November 2019, the USPSTF has studied 13 common cancers in the United States, screened them in 23 specific ages and genders, and made 17 recommendations, including Type A and B recommendations. There were only 5 types of screening tests, and up to 9 types of screening tests were opposed. For the remaining six screenings, USPSTF stated that there is not enough evidence to make a decision [1 ] . It should be noted that some common cancers in China, such as liver cancer, gastric cancer, and esophageal cancer, are relatively rare in the United States, and therefore are not included in the scope of the USPSTF study.
Why is the USPSTF negative on most early cancer screening programs?
Look first at the screenings recommended by the USPSTF. The two Type A screenings are colorectal cancer screening for middle-aged and elderly people aged 50 to 75, and cervical cancer screening for women aged 21 to 65. The three types of B screening are lung cancer screening for smokers aged 55 to 80 years, breast cancer screening for women aged 50 to 74 years, and a history of ovarian, fallopian tube, and peritoneal cancer in my or my family, or a relative Genetic counselling and genetic test screening for women with the breast cancer susceptibility gene BRCA1 / 2.
Colorectal and cervical cancer-screening is highly recommended
Colorectal cancer is the second most common cause of cancer deaths in the United States, and it usually occurs in the 65-74 age group. There is sufficient clinical evidence to show thatScreening for symptomatic patients can significantly reduce the incidence and mortality of colorectal cancer. This is because most colorectal cancers evolved from the development of polyps in the large intestine. This process usually takes about ten years. During this period, most patients have no obvious clinical symptoms, or only mild, undetectable Bleeding. Large bowel polyps and the bleeding they cause can be detected with colonoscopy or a stool occult blood test. Once a gastroenterologist finds a polyp during a colonoscopy, it can be removed and sent to a pathological examination to determine its nature.
Although most polyps are benign and do not become cancerous, the hidden dangers of colorectal cancer are eliminated after the cancerous polyps are removed. Because of this, the USPSTF classifies colorectal cancer screening in the middle to older age group as A. For elderly people aged 76 to 85, the chance of death due to other causes increases, and the potential net benefit of screening for colorectal cancer decreases. Therefore, the USPSTF recommends that doctors should use the current health status and previous medical history of each patient Decide whether to screen for colorectal cancer (C-screening) . Screening for colorectal cancer is less relevant after age 85, so colorectal cancer screening in these older adults is classified as a class D disapproval.
The latest epidemiological study found that the incidence of colorectal cancer has become younger in recent years. [2 ] . The USPSTF is currently investigating whether it is proposed to reduce the age at which screening begins from 50 to 40. The results are promising.
Cervical cancer is a common gynecological malignant tumor caused by high-risk human papilloma virus (hrHPV) infection. In 1928, Greek-American doctor Papniklau (George Papanicolaou) reported that cells were collected from the surface of the cervix and smeared on glass slides Put it under a microscope and observe. According to the cell morphology, you can distinguish between normal cells and abnormal cells with precancerous lesions. This test is called the Pap test (span class = “text-remarks” label = “Remarks”> (Pap test) . Since the 1940s, the cervical smear method has been used for the early screening of cervical cancer, and it has gradually been promoted. After the diagnosed precancerous lesions are cured, the hidden dangers of cervical cancer can be eliminated. From 1975 to 2010, the incidence of cervical cancer in American women has halved. From 2000 to 2015,The death toll from cervical cancer per 100,000 people has also fallen from 2.8 to 2.3 per year.
Because of the obvious benefits of cervical cancer screening, the USPSTF recommends that women aged 21 to 65 undergo cervical smear cytology and hrHPV virology tests every 3 to 5 years. (Type A screening) .
It can be seen that the cancer screening recommended by the USPSTF, especially the type A screening, has been clinically proven to effectively reduce the incidence and mortality of cancer. So why did the USPSTF oppose certain screenings? Bottom line: Clinical practice has proven that screening can lead to over-diagnosis and over-treatment.
Thyroid Cancer-Opposition Screening
One of the screenings that the USPSTF opposes is screening for thyroid cancer. Thyroid cancer is the most common malignant tumor of the endocrine system, and its incidence is three times higher in women than in men. Masses of the thyroid on both sides of the patient’s neck can cause symptoms such as difficulty breathing, swallowing, and hoarseness; in the later stages, they can be transferred to the lungs, brain, bones and other parts, causing death.
The South Korean government began universal screening of five common cancers in 1999: breast cancer, cervical cancer, bowel cancer, stomach cancer, and liver cancer. Screening is free for most people and only charges a small fee to high-income earners. Thyroid cancer is not included in the scope of the census. However, due to the simplicity and low cost of ultrasound for thyroid cancer, it is often used by medical units as an additional cancer test at their own expense. In various medical examination items that many hospitals are vigorously promoting, in addition to expensive and complicated MRI and CT scans, they also include ultrasound examination of the thyroid gland. Even some family doctors ‘clinics have ultrasound diagnostic instruments that can scan patients’ thyroid glands at any time.
Driven by economic benefits, Korean medical institutions are very enthusiastic about conducting ultrasound screening for thyroid cancer. On the other hand, due to the vigorous publicity of the government and the media, the concept of “early detection and early treatment” for all kinds of cancers has gained popularity. More and more Koreans have undergone thyroid ultrasonography, and the number of newly discovered thyroid cancer cases has also increased. From 1993 to 2011, the number of cases has increased by 13 times, reaching 40,000 people per year, and it has become the morbidity among 50 million Koreans The highest cancer is [3 ] .
Newly discovered patients with thyroid cancer almost always receive surgery: two-thirds are total thyroidectomy and one-third are partial thyroidectomy.The tumor removed is getting smaller and smaller. In a hospital, only 14% of thyroid cancers removed in 1995 accounted for less than 1 cm in diameter, and this proportion reached 56% ten years later. Although Korean thyroid cancer treatment guidelines do not recommend surgery for tumors smaller than 0.5 cm, many doctors and patients still “kill by mistake, never let go”: Cut! In all cases of thyroidectomy, tumors smaller than half a centimeter account for a quarter.
This anti-thyroid cancer campaign in Korea is unsuccessful in terms of the number of cases detected and treated. What about the effect on saving lives and improving health? From 1993 to 2011, the number of patients who died of thyroid cancer each year remained between 300 and 400, without any decrease. [3 ] . Around the same period, the same trend was found in Zhejiang province, where China’s economy is more developed: from 2000 to 2012, the diagnosis rate of thyroid cancer increased significantly, but the mortality rate remained stable. [4 ] .
Since so many thyroid cancer cases have been detected by ultrasound, these early cancers have been removed once and for all. Why has the number of thyroid cancer deaths not decreased?
As early as 1947, a pathologist published a paper in the New England Journal of Medicine, reporting that thyroid cancer is often found when dissecting corpses dying from other diseases, indicating that many cases of thyroid cancer can be asymptomatic until the patient Died for other reasons [5 ] . It is estimated that at least one-third of adults have thyroid cancer without knowing it until they finish their lives [6 ] . For such individuals, it is found that the thyroid cancer they carry is purely overdiagnosed, and treatment is overtreatment. Ultrasound screening, while discovering tumors, has also completely disrupted the lives of patients and removed them from their original calm. Cancer survival has turned into diseased survival that has plummeted in quality.
Applying the principle of “early detection and early treatment” to asymptomatic thyroid cancer is an endless error, because thyroidectomy is not without consequences. Most postoperative patients must receive thyroid hormone replacement therapy for life. The dosage of the replacement hormone is difficult to grasp correctly. If the dosage is too high, symptoms of hyperthyroidism such as sweating, palpitations, wasting and fatigue may occur; if the dosage is too low, symptoms of hypothyroidism such as lethargy, depression, and weight gain may occur. Thyroidectomy may also affect other tissues near the thyroid gland, such as the nerves that control the vocal cords and the parathyroid glands that regulate calcium and phosphorus metabolism and bone metabolism in the body, causing a series of diseases such as vocal cord paralysis or hypocalcemia.
According to statisticsIn Korea, 11% of patients with thyroidectomy have hypoparathyroidism and 2% have vocal cord paralysis. South Korea has spent huge amounts of human and material resources to conduct a large-scale ultrasound screening of thyroid cancer, and the results obtained are only tens of millions of patients with sequelae after thyroidectomy.
It is undeniable that a small percentage of thyroid cancers found through ultrasound screening can grow, metastasize and eventually lead to death if left untreated. In 2017, South Korean researchers conducted a survey that will identify asymptomatic thyroid cancer cases (screening group) found by ultrasound screening, and Cases that were diagnosed only after clinical symptoms appeared (clinical group) were compared, and the result was that the (Phase 3, 4) patients, the survival rate of the screening group after treatment is higher than that of the clinical group; at the time of discovery, the (Phase 1 and 2) patients, there was no significant difference in survival rates between the two groups [7 ] . The conclusion is that ultrasound screening for early asymptomatic thyroid cancer has no significant benefit in extending survival after treatment.
Attentive readers may ask, any advanced cancer develops from an early cancer. How can there be no benefit in eradicating such a tumor at an early stage?
The crux of the problem is that not every asymptomatic early stage cancer will progress to a symptomatic late stage in a patient’s lifetime. Many early-stage thyroid cancers do not grow or grow slowly without treatment. On the other hand, some early-stage cancers have metastasized to other parts before being detected, and even after being actively treated, they are unable to return to the sky. Early treatment can reverse the course of cancer and prolong the life of patients, accounting for only a small proportion of all thyroid cancer cases. Unfortunately, our understanding of thyroid cancer today is far from being able to accurately predict the development trend of each early case of cancer. Because of this, the USPSTF classified thyroid cancer screening as a class D in disapproval as early as 1996, and confirmed it again in 2017.
In addition to thyroid cancer, the USPSTF opposes screening for malignant tumors at any age, as well as testicular cancer, pancreatic cancer, and ovarian cancer, and I and my family do not have a history of ovarian, fallopian tube, or peritoneal cancer.No genetic screening for women with breast cancer susceptibility gene BRCA1 / 2.
Prostate Cancer Screening-Be Careful
Another example of the consequences of over-examination and over-diagnosis is prostate cancer. Prostate cancer is a common cancer in men. It is the second leading cause of cancer death in American men after lung cancer. The main symptoms are dysuria, urinary retention, pain, hematuria or urinary incontinence, which can cause bone pain and fractures after being transferred to the bones. The morbidity and mortality of prostate cancer are related to race. For example, in the United States, African-American men have a lifetime risk of dying from prostate cancer that is twice as high as Asians, with the former being 4.2% and the latter 2.1%. Familial genetic factors are also linked to the risk of prostate cancer.
The prostate can produce a protein called prostate-specific antigen (PSA) , which is secreted into semen and has the ability to assist the sperm to swim, The function of egg fertilization. The blood of healthy people usually also contains trace amounts of PSA. Abrin (Richard Ablin) , a professor of pathology at the University of Arizona, was one of the earliest scholars to discover PSA. He invented the determination of PSA content in 1970. Methods.
In 1987, a group of researchers from Stanford University published a paper in the New England Journal of Medicine, reporting their findings: the larger the tumor in prostate cancer patients, the more advanced the PSA content in the serum. . In addition, after radical prostatectomy, the PSA content in the blood quickly dropped below the detection sensitivity. Based on this, the author of the paper proposes that serum PSA is a marker of prostate cancer and can be used to detect whether there is residual or recurring cancer tissue after surgery. It can also be used to evaluate the effect of radiation therapy on prostate cancer. > ] .
The determination of PSA in serum was originally only used to monitor the development of prostate cancer that has been diagnosed. For men with prostate cancer symptoms, doctors usually also measure PSA levels and cooperate with other tests to help diagnose. However, in 1994, the US Food and Drug Administration (FDA) approved the use of serum PSA in conjunction with digital rectal examination to screen for asymptomatic prostate cancer. The medical profession is encouraging men over 50 to check serum PSA at annual physical examinations as a screening for the prostateMeans of cancer. Individuals at high risk for prostate cancer, including men of African descent and male immediate family members of patients with prostate cancer, have begun screening down to 40 or 45 years.
Persons whose serum PSA exceeds the standard will undergo a biopsy. Pathological examination will be used to determine whether they have prostate cancer. Due to the widespread application of PSA, the number of cases of prostate cancer found has increased sharply, becoming the most common cancer for men in the United States other than skin cancer. Once diagnosed with prostate cancer, 90% of patients receive surgical resection or radiation therapy, whether or not they have symptoms.
How effective is the early detection and early treatment of prostate cancer through PSA screening? Clinical studies have shown that, after 13 years of regular screening for every 1,000 men from 55 to 69 years, the number of deaths due to prostate cancer is only about 1.3 fewer than that of a control group of the same age who has not been screened. There was no difference in total mortality in the groups [9 ] . On the other hand, the incidence of sequelae after treatment is extremely considerable: one in five patients who undergo surgical resection of the prostate have urinary incontinence and two thirds have sexual dysfunction; one in six patients receiving radiation therapy have fecal incontinence, Intestinal bleeding and other symptoms seriously affect patients’ quality of life. The older the patient, the more severe the sequelae.
After autopsy of a male body that died of a cause other than prostate cancer, it was found that more than 20% of the 50- to 59-year-olds had prostate cancer, and 70-79-year-olds had a higher proportion of prostate cancer. Up to 33% [9 ] . Although some patients with prostate cancer have a high degree of malignancy, they can rapidly develop, spread, and cause death, but like thyroid cancer, there are also a large number of patients with prostate cancer who will not experience symptoms of prostate cancer until death.
Large-scale clinical trials have shown that 20% to 50% of prostate cancers detected through screening are overdiagnosed. The older the patient, the higher the rate of overdiagnosis, because as he gets older, the patient is more likely to die from other diseases. For patients who have been overdiagnosed, the consequences of screening and treatment are to transform them from a state of cancer without survival, to patients who have been treated for the rest of their lives. Unfortunately, our test methods for prostate cancer today, whether it is serum PSA or the gold standard for diagnosis-biopsy pathology, cannot distinguish between two types of prostate cancer with very different prognosis.
PSA screening is widespread, and the consequences are not limited to overtreatment. Because of the increase in serum PSA levels, in addition to prostate cancer, there are a series of reasons such as prostate hypertrophy and inflammation, so PSA screening has a high false positive rate. ProBed research shows that if PSA screening is performed every 2 to 4 years, more than 15% of screening subjects after 10 years get at least one false positive result, and the resulting psychological and psychological symptoms such as tension and anxiety are considerable. Biopsy punctures to rule out false positives can cause side effects such as pain, bleeding, and infection, leaving screening subjects harmless.
Professor Abrin, who invented the PSA measurement method, was the first person who strongly opposed the use of PSA for screening for prostate cancer. In a 2010 article in the New York Times, he pointed out that approximately 30 million Americans are screened for PSA each year, costing more than $ 3 billion, but the result is “an extremely costly public health disaster.” He emphasized: “I have repeatedly tried to clarify that the determination of PSA cannot be used to detect prostate cancer, and more importantly, it cannot distinguish between two different types of prostate cancer-fatal and non-lethal.” [10 ] Abrin also sharply criticized some urologists and pharmaceutical companies in the United States for putting money above the well-being of patients, while the FDA failed to fulfill its responsibility to the public and succumbed to the interest groups and the pharmaceutical industry. Pressure to approve the use of PSA for screening for prostate cancer, resulting in abuse [11 ] .
As early as 1996, the USPSTF considered opposing PSA as a screening tool for prostate cancer in asymptomatic men. In 2008, the USPSTF advised against prostate cancer screening in men over 74 years of age. In 2012, after reviewing and summarizing the results of clinical studies, the USPSTF officially announced that prostate cancer screening for asymptomatic men was classified as Class D.
By 2018, according to the results of the new study, the USPSTF has amended the recommendations made [9 ] : against PSA screening for elderly people over 69 years old; Whether men aged 69 to 69 are regularly screened should be decided by patients and doctors after fully discussing the pros and cons of screening. (Class C ) . Factors to consider must include the patient’s family history, his or her health, and the patient’s values for weighing risks and benefits. The potential benefit of screening is to slightly reduce the risk of dying from prostate cancer in some individuals, but those who are screened must be fully aware of the various potential risks associated with screening, including false positive results and the side effects of biopsy and treatment, and Sequelae. Doctors should not impose screening on patients who are not willing to screen.
Breast Cancer Screening——Recommended, but urgently need improvement
Among women’s various cancers, breast cancer has the highest morbidity and mortality rate, and the age of onset is mostly after the age of 50. The main method of breast cancer screening is mammography mammography. In 2016, the USPSTF recommended that women between the ages of 50 and 74 undergo mammography every two years. (Type B screening) ; Women up to the age of 49, due to the lower incidence of breast cancer, reduce the potential benefits of screening. Based on family history and their wishes, they should decide whether to conduct screening after comprehensive consideration. (Category C screening) ; For elderly women over 75 years of age, due to insufficient clinical evidence, the USPSTF cannot decide whether to recommend screening. (Type I screening) .
Although mammography has been widely used, in recent years, doubts about breast cancer screening have increased. The main support for screening is that clinical studies have found that screening can reduce breast cancer mortality; opponents argue that the benefits of screening are not statistically significant, and the false positive rate is unacceptably high, leading to A large number of unnecessary biopsies.
The sensitivity of the molybdenum target test is about 87%. 10% [13 ] , that is, if you check 100 women without breast cancer, about 10 people will get a positive result. According to one study, the average risk of breast cancer in a 50-year-old woman within ten years is 2.85% [14 ] , or about 0.3% per year. At this rate, about 30 new breast cancers occur each year among 10,000 women. Assuming that 10,000 women undergo a molybdenum check, 26 of them will be detected.
In addition, you will get about 1,000 false positive results. In other words, every time a new case of breast cancer is detected, 38 people get a false positive result. In order to rule out these false positives, all 38 people need to undergo a series of follow-up tests, including biopsy tests that may have serious side effects. The lower the breast cancer risk of the screened population, the higher the cost of false positives for each breast cancer detected.
One of early asymptomatic breast cancers detected by screeningSome may grow very slowly and will not develop into a deadly advanced tumor during the lifetime of the patient; a small number of cases have metastasized when found, and treatment is completely ineffective. Such cases are overdiagnosed. Breast cancer screening leads to overdiagnosis of 11% to 22% [13 ] . Breast cancer cases whose lives have been saved after treatment are only part of all early cases. The physical and psychological trauma and pain that patients undergoing treatment, whether surgical resection, radiotherapy, or chemotherapy, regardless of the effect of the treatment, cannot be ignored.
How can I change the status of breast cancer (and some other cancers)
The risk of breast cancer is related to genetic factors, lifestyle and fertility history. It is known that the average risk of breast cancer in a 50-year-old woman in the United Kingdom within a decade is 2.85%, but if you consider various risk factors, the lowest risk in the entire population is 0.53%, the highest is 9.96%, a difference of nearly 20 times [14 ] ! Therefore, some scholars have proposed to abandon the current practice of determining whether to screen based on the age line, instead, determine the screening target based on the level of cancer risk, and focus on screening relatively high-risk groups of breast cancer.
In order to provide a theoretical basis for a new breast cancer screening program, a group of researchers in the UK used British life statistics to construct a hypothetical model to simulate the effect of screening based on breast cancer risk. [14 ] .
Suppose there are 10,000 women who are screened for breast cancer every three years starting at the age of 50, stop at the age of 69, and then follow up to the age of 85. During this period, screening will detect 875 cases of breast cancer, of which 239 will die from breast cancer. In addition, screening also resulted in 105 cases of overdiagnosis. After adjusting for the quality of life, the total number of years of survival of this 10,000 people is 128,892. If the scope of screening is limited to the 3,000 women with the highest comprehensive risk of breast cancer among this 10,000 people, the remaining 7,000 will not be screened, and they will seek treatment only after symptoms of breast cancer appear. Expenses will be reduced by approximately £ 500,000 (– 9.5%) and 99 cases of breast cancer detected will be reduced by (– 11%) , 23 breast cancer deaths increased (+ 9.6%) , and overdiagnosis significantly reduced 75 cases (– 71% ) . After adjusting for the quality of life, the total number of years of survival will increase by 443 years. (+ 0.3%) .
According to the results of this simulation study, if individuals with a relatively low risk of breast cancer are excluded from the screening, although it may increase the number of breast cancer deaths and reduce the total number of years of survival, they are overdiagnosed. The number of people will be greatly reduced, and the quality of life of these people will obviously improve during their lifetime, so the total number of years of survival will increase slightly after adjusting for the quality of life. Savings due to fewer screenings can be diverted to other public health programs that are more effective in improving people’s health. For the whole society, the cost-effectiveness of doing so is obvious.
It can be seen that under the circumstances that the existing inspection and diagnosis technology is not perfect, selective screening for various cancers in specific populations rather than one-size-fits-all screening is to improve screening efficiency, An effective measure to reduce overdiagnosis. But to achieve such a change, resistance will inevitably be encountered. Many people have long preconceived that, for cancer prevention, it is not harmful to be cautious. Regardless of the risk of cancer, “check it out and rest assured.” Some unscrupulous practitioners in the health industry are taking advantage of this excessive cautiousness to take advantage of the opportunity to sell “medical examination packages” that include various unnecessary and expensive examination items and make a profit from them. It is the incumbent responsibility of medical staff to reverse the people’s misconceptions about cancer screening.
The fight between humans and cancer is an uphill battle. Advances in medical research will provide increasingly effective new weapons to defeat cancer, especially the development of personalized precision medicine, which is expected to bring the level of cancer diagnosis and treatment to an unprecedented level. At present, how can we make full use of the existing medical technology, make reasonable use of limited social resources, formulate a cancer prevention and control strategy that suits the national conditions, and maximize the benefits and reduce the damage in cancer screening? It is a complex systems project that requires the joint efforts of governments, medical and scientific researchers, educators, the pharmaceutical industry, the media, and the general public.
Main reference:
[1] USPSTF. https: //www.uspreventiveservicestaskforce.org /
[2] Potter JD. Rising rates of colorectal cancer in younger adults. BMJ 2019. 365: 14280.
[3] Ahn HS et al. Korea’s thyroid-cancer “epidemic” — screening and overdiagnosis. N Engl J Med 2014. 371: 1765-7. < / p>
[4] Du L et al. Thyroid cancer: trends in incidence, mortality and clinical-pathological patterns in Zhejiang Province, Southeast China. BMC Cancer 2018. 18: 291. < / span>
[5] Vanderlaan WP. The occurrence of carcinoma of the thyroid gland in autopsy material. N Engl J Med 1947. 237: 221-2.
[6] Harach HR et al. Occult papillary carcinoma of the thyroid: a “normal” finding in Finland — a systematic autopsy study. Cancer 1985. 56: 531-8.
[7] Jung Y-S et al. Long-term survival of patients with thyroid cancer according to themethods of tumor detection: A nationwide cohort study in Korea. PLOS ONE April 16, 2018. https://doi.org/10.1371/journal.pone.0194743.
[8] Rao AR et al. The discovery of prostate-specific antigen. BJU Int. 2008. 101: 5-10.
[9] Grossman DC et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018. 319: 1901-13.
[10] Ablin RJ. The Great Prostate Mistake. New York Times Mar 9, 2010.
[11] O’Callaghan T. Prostate cancer test has been misused for money. New Scientist Feb 12, 2014.
[12] Breast Cancer Surveillance Consortium (BCSC). Sensitivity, specificity, and false negative rate for 1,682,504 screening mammography examinations from 2007-2013. 2017. https: // www. bcsc-research.org/statistics/screening-performance-benchmarks/screening-sens-spec-false-negative.
[13] Nelson HD et al. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 US Preventive Services Task Force Recommendation. Ann Intern Med 2016.164: 244 -55.
[14] Pashayan N et al. Cost-effectiveness and Benefit-to-Harm Ratio of Risk-Stratified Screening for Breast Cancer. JAMA Oncol 2018. 4: 1504–10.
This article is from WeChat public account: Repu (fanpu2019) , author ： 何笑松