Об скрининг рака
Jan. 13th, 2016 08:54 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
kodak2004Неплохое изложение. Маятник потихоньку качается обратно, швейцарцы не дадут соврать.
А PSA уже даже защищать приходится. Вот это дожились :)
P.S. Хороший комментарий в Medscape (нужна регистрация):
Richard L. Schilsky, MD, chief medical officer for the American Society of Clinical Oncology (ASCO), said that although, in general, ASCO supports cancer screening, "it's a very imperfect process."
The value of screening depends on the degree of risk for the condition being screened in the population of interest, the sensitivity and specificity of the screen, and the natural history of the disease detected by the screening test, Dr Schilsky told Medscape Medical News.
"It's the combination of these three factors that's getting all of us into so much difficulty in interpreting screening data," he said.
The often high variability in the natural history of many cancers has been the source of particular confusion and uncertainty surrounding screening, he noted.
For example, there is little value in screening for aggressive cancers for which interventions are unlikely to make a difference in outcomes, no matter how early the disease can be detected.
Conversely, "if the cancer is never going to kill you, no matter what the doctors do, then screening won't help either," he said.
Additionally, there are some cancers for which treatments are sufficiently effective that they can be successfully managed whether they are diagnosed at an early or later stage.
"When you consider all these factors, the number of individuals who will actually benefit from detecting a screen-detected cancer is very small," Dr Schilsky said.
"These are highly complicated and highly nuanced issues," he continued. "Many doctors don't even fully understand many of these nuances, and certainly many, if not most, doctors don't have the time to really sit with the patient and work through all of these issues at the level of detail that's really necessary to communicate clearly what the potential risks and benefits are," he said.
Спасибо за озвучивание неприятной правды. Диалог на приеме у врача по поводу скрининга - это обычно профанация, а не реальное взвешивание пользы и риска. Просто в силу огромного количества нюансов и отстутствия времени на часовые лекции по обучению концептам, необходимым для их понимания, как и было сказано.
P.S. Еще немного Уэлша.
А PSA уже даже защищать приходится. Вот это дожились :)
P.S. Хороший комментарий в Medscape (нужна регистрация):
Richard L. Schilsky, MD, chief medical officer for the American Society of Clinical Oncology (ASCO), said that although, in general, ASCO supports cancer screening, "it's a very imperfect process."
The value of screening depends on the degree of risk for the condition being screened in the population of interest, the sensitivity and specificity of the screen, and the natural history of the disease detected by the screening test, Dr Schilsky told Medscape Medical News.
"It's the combination of these three factors that's getting all of us into so much difficulty in interpreting screening data," he said.
The often high variability in the natural history of many cancers has been the source of particular confusion and uncertainty surrounding screening, he noted.
For example, there is little value in screening for aggressive cancers for which interventions are unlikely to make a difference in outcomes, no matter how early the disease can be detected.
Conversely, "if the cancer is never going to kill you, no matter what the doctors do, then screening won't help either," he said.
Additionally, there are some cancers for which treatments are sufficiently effective that they can be successfully managed whether they are diagnosed at an early or later stage.
"When you consider all these factors, the number of individuals who will actually benefit from detecting a screen-detected cancer is very small," Dr Schilsky said.
"These are highly complicated and highly nuanced issues," he continued. "Many doctors don't even fully understand many of these nuances, and certainly many, if not most, doctors don't have the time to really sit with the patient and work through all of these issues at the level of detail that's really necessary to communicate clearly what the potential risks and benefits are," he said.
Спасибо за озвучивание неприятной правды. Диалог на приеме у врача по поводу скрининга - это обычно профанация, а не реальное взвешивание пользы и риска. Просто в силу огромного количества нюансов и отстутствия времени на часовые лекции по обучению концептам, необходимым для их понимания, как и было сказано.
P.S. Еще немного Уэлша.
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no subject
Date: 2016-01-14 04:31 am (UTC)Выживаемость ведь не единственный критерий. Например, если при более раннем диагнозе можно обойтись менее инвазивным вмешательством - оно того стоит.
Кстати, насчет меланомы я читала и так и не поняла, что там имеет смысл, а что нет. Ну и по поводу колоноскопии разногласий вроде ни у кого нет.
no subject
Date: 2016-01-14 11:12 pm (UTC)Да, но в этот раз разобрали конкретно лозунг "скрининг спасет жизни". Неправда. По крайней мере, имеющиеся исследования не позволяют сделать такой вывод.
>> Например, если при более раннем диагнозе можно обойтись менее инвазивным вмешательством - оно того стоит.
Здесь нужно знать вероятность бесполезного overtreament и вероятность того, что действительно полезное вмешательство, улучшающее продолжительность/качество жизни может быть сделано менее инвазивно блягодаря скринингу, чтобы делать хоть сколько-нибудь информированное решение. Количественных данных по второму вопросу у нас нет. А "можно" - это очень растяжимое понятие. Можно у каждого тысячного, проходящего скрининга, и можно у каждого миллионного - огромная разница.
>> Ну и по поводу колоноскопии разногласий вроде ни у кого нет.
На самом деле, есть + https://www.mailman.columbia.edu/public-health-now/news/colonoscopy-right-tool-colon-cancer-screening
К тому же, вся критика маммографий здесь тоже применима. Просто скрининг РМЖ более горячий топик, на колоректальный рак меньше внимания остается.
P.S. Еще немного Уэлша.