Harvard Medical School symposium. Boston (USA), 1996/03/28.
While intense controversy exists regarding screening for breast, colorectal, and prostate cancer, a consensus exists regarding lung cancer screening.
All organizations recommend against any efforts to detect early lung cancer because each of four randomized controlled trials (RCTs) has failed to demonstrate a significant reduction in lung cancer mortality as a result of screening.
Disease-specific mortality is assumed to represent the best measure of screening effectiveness in RCTs, because it is not subject to confounding by lead time, length, or overdiagnosis biases.
However, the effects of these biases are predictable, so accurate assessments of the degree of confounding by these biases can be made.
Moreover, the ability of mortality to accurately reflect cancer death rates depends on the ability of randomization to create experimental and control populations that have an equal risk of dying of the disease under study, except insofar as early detection may reduce that risk.
Because the majority of participants in screening trials never develop the disease under investigation, small absolute differences in disease risk between groups often persist despite randomization, and such differences translate into much larger proportional differences in the size of subgroups at risk for disease-specific mortality.
This effect confounds the ability of disease-specific mortality to accurately measure screening effectiveness. (...)
Mots-clés Pascal : Carcinome, Bronchopulmonaire, Etats Unis, Amérique du Nord, Amérique, Dépistage, Mortalité, Homme, Canada, Article synthèse, Appareil respiratoire pathologie, Poumon pathologie, Bronche pathologie, Tumeur maligne
Mots-clés Pascal anglais : Carcinoma, Bronchopulmonary, United States, North America, America, Medical screening, Mortality, Human, Canada, Review, Respiratory disease, Lung disease, Bronchus disease, Malignant tumor
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0031629
Code Inist : 002B11A. Création : 17/04/1998.