programas cribado cancer

Nota bibliográfica cribado c miscelánea 2014-07/08

Lansdorp-Vogelaar PhD I, Gulati MS R, Mariotto PhD AB, Schechter MD, MA CB, de Carvalho MSc TM, Knudsen PhD AB, et al. Personalizing Age of Cancer Screening Cessation Based on Comorbid Conditions: Model Estimates of Harms and Benefits. Ann Intern Med. Philadelphia; 2014;161(2):104. Available from: http://search.proquest.com/docview/1545851026?accountid=15293.

Lansdorp-Vogelaar et al estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Screening 1,000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons.

Narod SA. Modern approaches to cancer prevention: Universal or personal? J Cancer Policy. (0). Available from: http://www.sciencedirect.com/science/article/pii/S2213538314000162.  doi: http://dx.doi.org/10.1016/j.jcpo.2014.05.002.

Moynihan R, Henry D, Moons KGM. Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much. PLoS Med. 2014;11(7):e1001655. Available from: http://dx.doi.org/10.1371/journal.pmed.1001655.
 
Overdiagnosis and related overtreatment are increasingly recognised as major problems. “Positive” average results from trials of treatments can mask situations where many participants at low risk of disease may receive no benefit. The evaluation of diagnostic tests usually involves assessing how well tests detect presence versus absence of a certain disease—rather than how well they detect clinically meaningful stages of disease. Changes to disease definitions typically do not involve evaluation of potential harms of overdiagnosis, and are often conducted by heavily conflicted panels. We offer suggestions for improving the way evidence is produced, analysed, and interpreted, to help combat overdiagnosis and related overtreatment. These include routine consideration of overdiagnosis and related overtreatment in studies of tests and treatments, and clearer stratification by baseline risk to identify treatment thresholds where benefits are likely to outweigh harms

Royce TJ, Hendrix LH, Stokes WA, Allen IM, Chen RC. Cancer Screening Rates in Individuals With Different Life Expectancies. JAMA Intern Med. 2014; Available from: http://archinte.jamanetwork.com/article.aspx?articleid=1897549.  doi: 10.1001/jamainternmed.2014.3895. PMID: 25133746.

Conclusions and Relevance: A substantial proportion of the US population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit. These results suggest that overscreening is common in both men and women, which not only increases health care expenditure but can lead to net patient harm.

Cervera Deval J, Sentís Crivillé M, Zulueta JJ. Sobrediagnóstico en cribado de cáncer. Radiologia. 2014;(0). Available from: http://www.sciencedirect.com/science/article/pii/S0033833814001027.  doi: http://dx.doi.org/10.1016/j.rx.2014.06.007.   

Resumen En los programas de diagnóstico precoz, se considera sobrediagnóstico al diagnóstico de una enfermedad que sin cribado nunca se hubiera diagnosticado, y como se espera que dicho diagnóstico no cause la muerte, se trata innecesariamente. El sobrediagnóstico es un sesgo del propio cribado y un efecto no deseado de la prevención secundaria y de la mejora de la sensibilidad de las técnicas diagnósticas. A priori es difícil de discriminar qué diagnósticos son los clínicamente relevantes y en cuáles se podría evitar el tratamiento. Para minimizar el efecto de sobrediagnóstico, el cribado debe dirigirse a población considerada de riesgo. Abstract

Gross CP. Cancer Screening in Older Persons: A New Age of Wonder. JAMA Intern Med. 2014; Available from: http://archinte.jamanetwork.com/article.aspx?articleid=1897541. doi: 10.1001/jamainternmed.2014.3901. PMID: 25133660
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