programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c miscelánea 2013-07/08

Marshall H. Workplace cancer screening. The Lancet Oncology 2013 7;14(8):694. DOI:
Epstein RM, Gramling RE. What Is Shared in Shared Decision Making? Complex Decisions When the Evidence Is Unclear. Medical Care Research and Review 2013 February 01;70(1 suppl):94S-112S. DOI:10.1177/1077558712459216.

Patient involvement in decisions is central to patient-centered care. Yet many important decisions must be made in complex, ambiguous clinical situations in which all possible options cannot be known, evidence is inadequate to inform patients’ preferences fully, and/or patients are unclear about their desired level of involvement. In these situations, preferences are shaped by affect, framing, and “collaborative cognition” among clinicians, patients, and their families; thus, decisions are often relational, dynamic, iterative, provisional, and/or conditional. Clinicians can help patients achieve greater autonomy by engaging both intuitive and deliberative decision-making processes (“whole mind”) and involving others in exploring, clarifying, and co-constructing patients’ preferences (“shared mind”). Clinical and interpersonal relationships can promote effective decision making through developing a shared attentional focus, tailoring information, and identifying conditions under which provisional preferences might change. Information technology and health systems offer untapped potential to deepen the relationships and conversations within which decisions are made.

Otsuka I, Kameda S, Hoshi K. Early detection of ovarian and fallopian tube cancer by examination of cytological samples from the endometrial cavity. Br J Cancer 2013 Aug 6;109(3):603-609. DOI:10.1038/bjc.2013.402; PMID:23868002. PMCID:PMC3738141.

Conclusion:Endometrial cytological testing can detect early-stage ovarian, tubal, and peritoneal HGSCs without detectable pelvic masses and may be useful for ovarian cancer screening.

Esserman LJ, Thompson IM, Reid B. Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement. JAMA 2013 Jul 29 DOI:10.1001/jama.2013.108415; PMID:23896967.

Printz C. Target: melanoma: skin cancer screenings hold promise to reduce mortality rates, but usage of widespread screening lags. Cancer 2013 Jul 1;119(13):2359-2360. DOI:10.1002/cncr.28205; PMID:23775430.

Etzioni R, Gulati R, Mallinger L, Mandelblatt J. Influence of study features and methods on overdiagnosis estimates in breast and prostate cancer screening. Ann Intern Med 2013 Jun 4;158(11):831-838. DOI:10.7326/0003-4819-158-11-201306040-00008; PMID:23732716. PMCID:PMC3733533.

Knowledge of the likelihood that a screening-detected case of cancer has been overdiagnosed is vitally important to make treatment decisions and develop screening policy. An overdiagnosed case is an excess case detected by screening. Estimates of the frequency of overdiagnosis in breast and prostate cancer screening vary greatly across studies. This article identifies features of overdiagnosis studies that influence results and shows their effect by using published research. First, different ways to define and measure overdiagnosis are considered. Second, contextual features and how they affect overdiagnosis estimates are examined. Third, the effect of estimation approach is discussed. Many studies use excess incidence under screening as a proxy for overdiagnosis. Others use statistical models to make inferences about lead time or natural history and then derive the corresponding fraction of cases that are overdiagnosed. This article concludes with questions that readers of overdiagnosis studies can use to evaluate the validity and relevance of published estimates and recommends that authors of studies quantifying overdiagnosis provide information about these features.


Nota bibliográfica cribado c miscelánea 2013-06

Adriaensen WJ, Mathei C, Buntinx FJ, Arbyn M. A framework provided an outline toward the proper evaluation of potential screening strategies. J Clin Epidemiol 2013 Jun;66(6):639-647. DOI:10.1016/j.jclinepi.2012.09.018; PMID:23395357.
CONCLUSION: Our framework provides an outline toward the proper evaluation of potential screening strategies before considering implementation.


Nota bibliográfica cribado c miscelánea 2013-05

Mitka M. Evidence lacking for benefit from oral cancer screening. JAMA 2013 May 8;309(18):1884. DOI:10.1001/jama.2013.4913; 10.1001/jama.2013.4913. PMID:23652503.

Pinsky PF, Zhu C, Skates SJ, Black A, Partridge E, Buys SS, et al. Potential effect of the risk of ovarian cancer algorithm (ROCA) on the mortality outcome of the Prostate, Lung, Colorectal and Ovarian (PLCO) trial. Int J Cancer 2013 May 1;132(9):2127-2133. DOI:10.1002/ijc.27909; 10.1002/ijc.27909. PMID:23065684.

Recently, the Prostate, Lung, Colorectal and Ovarian (PLCO) Trial reported no mortality benefit for annual screening with CA-125 and transvaginal ultrasound (TVU). Currently ongoing is the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), which utilizes the risk of ovarian cancer algorithm (ROCA), a statistical tool that considers current and past CA125 values to determine ovarian cancer risk. In contrast, PLCO used a single cutoff for CA125, based on current levels alone. We investigated whether having had used ROCA in PLCO could have, under optimal assumptions, resulted in a significant mortality benefit by applying ROCA to PLCO CA125 screening values. A best-case scenario assumed that all cancers showing a positive screen result earlier with ROCA than under the PLCO protocol would have avoided mortality; under a stage-shift scenario, such women were assigned survival equivalent to Stage I/II screen-detected cases. Updated PLCO data show 132 intervention arm ovarian cancer deaths versus 119 in usual care (relative risk, RR = 1.11). Forty-three ovarian cancer cases, 25 fatal, would have been detected earlier with ROCA, with a median (minimum) advance time for fatal cases of 344 (147) days. Best-case and stage-shift scenarios gave 25 and 19 deaths prevented with ROCA, for RRs of 0.90 (95% CI: 0.69-1.17) and 0.95 (95% CI: 0.74-1.23), respectively. Having utilized ROCA in PLCO would not have led to a significant mortality benefit of screening. However, ROCA could still show a significant effect in other screening trials, including UKCTOCS.


Nota bibliográfica cribado c miscelánea 2013-02

Edgren G, Lagiou P, Trichopoulos D, Adami H. Screening, case finding or primary cancer prevention in the developing world? Eur J Epidemiol 2013 02/27:1-4. DOI:10.1007/s10654-013-9788-9. Enlace: 


Nota bibliográfica cribado c miscelánea 2013-01

Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O'Brien S, Walter LC. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ 2012 Jan 8;346:e8441. DOI:10.1136/bmj.e8441. PMID:23299842

CONCLUSIONS: Our results suggest that screening for breast and colorectal cancer is most appropriate for patients with a life expectancy greater than 10 years. Incorporating time lag estimates into screening guidelines would encourage a more explicit consideration of the risks and benefits of screening for breast and colorectal cancer.


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