| Selective screening based on family history misses most prostate cancers
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| 来源:Reuters Health ;添加日期:2002-8-4;编辑:急救快车 |
Using family history as the basis for selective screening with prostate-specific antigen (PSA) would result in missing most cases of prostate cancer, according to a report in the June 1st Journal of Clinical Oncology.
Early screening of men with first-degree relatives diagnosed with prostate cancer has been recommended, despite the lack of evidence for an associated reduction in mortality, the authors explain.Dr. Tuukka Minen from the Finnish Cancer Registry in Helsinki, Finland and colleagues used results from a prostate cancer screening trial to assess the importance of family history to the sensitivity and specificity of screening.Eleven percent of the 964 men with a positive family history had serum PSA levels of at least 4 ng/mL and were referred for prostate biopsy, the authors report. Twenty-nine of these men proved to have tumors, for a detection rate of 3%.The detection rate was similar (2.4%) among the 19,347 men without a family history of prostate cancer, the report indicates.The risk of prostate cancer associated with a positive family history was not significantly increased, the researchers note, and the characteristics of the cancers detected did not differ among men with a positive family history. Because of the low sensitivity of family history as a screening criterion (5.9%), the results indicate that limiting screening to men with a positive family history would have missed just over 94% of the prostate cancers detectable by PSA screening."Genetic factors are unlikely to provide a successful approach for selective prostate cancer screening as public health policy," Dr. Mnen told Reuters Health."In addition to age, no other criteria seem to be available to limit screening (in order to reduce costs and possible harms) at population level, as a selective screening policy based on family history is likely to miss most cancers detectable through PSA testing," Dr. Minen said.Contrary to guidelines, Dr. Minen recommends against widespread screening of asymptomatic men. "In our opinion, PSA screening should not be practiced until the evidence of mortality reduction is available from ongoing screening trials," he said."However, men with symptoms and those requesting PSA testing themselves should be examined according to common clinical practice, including PSA determination," Dr. M鋕inen concluded. Men who request PSA screening should be informed in advance of the lack of evidence for the value of screening and its potential for overdiagnosis, he added.
J Clin Oncol 2002;20:2658-2663.
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