摘要
目的对Cochrane综述中的观点进行评估：Forrest的报道曾引领英国进行乳腺癌筛查，但更新后的分析结果表明，乳腺钼靶筛查可能弊大于利。设计经过文献搜索，利用相关的系统性回顾、试验和其他研究模型的数据对Forrest模型进行补充和更新，并建立一个能够重复Forrest结果的生命表模型。研究对象进行乳腺癌筛查的50岁以上女性。主要评价指标质量调整生存年（QALYs），把从筛查中获益的生存时间和由于假阳性结果或手术而导致的生活质量下降进行综合评估。结果在评估中加入筛查的负面影响后，更新的数据显示筛查20年后的累计质量调整生存年数降低了一半以上，由3301降至1536。Coehrane综述中最好的结果表明筛查的最初7年里质量调整生存年数为负值，10年后上升至70，20年后为834。敏感度分析表明这些结果，尤其是10年以上的数据，足以证明各种假设。另外提到手术导致的不利影响的程度和持续时间的重要性。结论这项研究证明10年以上的乳腺癌筛查有害无益。
Objective To assess the claim in a Cochrane review that mammographic breast cancer screening could be doing more harm than good by updating the analysis in the Forrest report, which led to screening in the United Kingdom. Design Development of a life table model, which replicated Forrest＇s results before updating and extending them with data from relevant systematic reviews, trials, and other models based on purposive literature searches. Participants Women aged 50 and over invited for breast cancer screening. Main outcome measures Quality adjusted life years （QALYs）, combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery. Results Inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536 or by more than half. The best estimates from the Cochrane review generated negative QALYs for the first seven years of screening, 70 QALYs after 10 years, and 834 QALYs after 20 years. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery. Conclusions This analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening. BMJ 2011 ;343 ：d7627
出处
《英国医学杂志中文版》
2012年第2期109-109,共1页
The BMJ Chinese Edition
