使用多种癌症检测试验进行癌症筛查:转化科学综述。

IF 503.1 1区 医学 Q1 ONCOLOGY CA: A Cancer Journal for Clinicians Pub Date : 2024-03-22 DOI:10.3322/caac.21833
Wendy S. Rubinstein MD, PhD, Christos Patriotis PhD, MSc, Anthony Dickherber PhD, Paul K. J. Han MD, MA, MPH, Hormuzd A. Katki PhD, Elyse LeeVan MD, MPH, Paul F. Pinsky PhD, Philip C. Prorok PhD, Amanda L. Skarlupka PhD, Sarah M. Temkin MD, Philip E. Castle PhD, MPH, Lori M. Minasian MD
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引用次数: 0

摘要

多癌症检测(MCD)试验使用单一的、易于获得的生物样本(如血液)来同时筛查一种以上的癌症。多癌症检测可用于改善早期癌症检测,包括目前缺乏有效筛查方法的癌症。然而,这些检测的益处和害处尚不清楚,也没有量化。MCD 检测与传统癌症筛查检测的不同之处在于,导致检测结果呈阳性的器官是未知的,因此可能需要进行广泛的诊断工作,以确认潜在癌症的位置和类型。在两项涉及 16,000 多人的前瞻性研究中,MCD 检测发现了一些目前未推荐筛查的癌症,包括胰腺癌、卵巢癌、肝癌、子宫癌、小肠癌、口咽癌、骨癌、甲状腺癌和血液系统恶性肿瘤的早期阶段。报告的 MCD 检测灵敏度从 27% 到 95% 不等,但器官不同,灵敏度也不同,早期癌症的灵敏度较低,因为早期癌症的治疗毒性最低,治愈的可能性最大。阴性 MCD 结果带来的虚假保证可能会降低筛查的依从性,从而有可能丧失标准护理筛查带来的公认公共卫生益处。需要进行前瞻性临床试验来解决以下不确定因素:MCD 检测无症状个体中不同癌症的准确性;这些检测是否能足够早地检测出癌症以进行有效治疗和降低死亡率;这些检测在多大程度上会导致癌症过度诊断和过度治疗;MCD 检测是否在所有人群中都同样有效;以及对检测呈阳性的患者进行适当的诊断评估和随访。
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Cancer screening with multicancer detection tests: A translational science review

Multicancer detection (MCD) tests use a single, easily obtainable biospecimen, such as blood, to screen for more than one cancer concurrently. MCD tests can potentially be used to improve early cancer detection, including cancers that currently lack effective screening methods. However, these tests have unknown and unquantified benefits and harms. MCD tests differ from conventional cancer screening tests in that the organ responsible for a positive test is unknown, and a broad diagnostic workup may be necessary to confirm the location and type of underlying cancer. Among two prospective studies involving greater than 16,000 individuals, MCD tests identified those who had some cancers without currently recommended screening tests, including pancreas, ovary, liver, uterus, small intestine, oropharyngeal, bone, thyroid, and hematologic malignancies, at early stages. Reported MCD test sensitivities range from 27% to 95% but differ by organ and are lower for early stage cancers, for which treatment toxicity would be lowest and the potential for cure might be highest. False reassurance from a negative MCD result may reduce screening adherence, risking a loss in proven public health benefits from standard-of-care screening. Prospective clinical trials are needed to address uncertainties about MCD accuracy to detect different cancers in asymptomatic individuals, whether these tests can detect cancer sufficiently early for effective treatment and mortality reduction, the degree to which these tests may contribute to cancer overdiagnosis and overtreatment, whether MCD tests work equally well across all populations, and the appropriate diagnostic evaluation and follow-up for patients with a positive test.

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来源期刊
CiteScore
873.20
自引率
0.10%
发文量
51
审稿时长
1 months
期刊介绍: CA: A Cancer Journal for Clinicians" has been published by the American Cancer Society since 1950, making it one of the oldest peer-reviewed journals in oncology. It maintains the highest impact factor among all ISI-ranked journals. The journal effectively reaches a broad and diverse audience of health professionals, offering a unique platform to disseminate information on cancer prevention, early detection, various treatment modalities, palliative care, advocacy matters, quality-of-life topics, and more. As the premier journal of the American Cancer Society, it publishes mission-driven content that significantly influences patient care.
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