[老年人预防三种主要癌症的机会和风险:乳腺癌、前列腺癌和结肠直肠癌]。

G F Kolb
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引用次数: 2

摘要

乳腺癌(BC)、前列腺癌(PC)和结直肠癌是世界范围内最常见的恶性肿瘤,也是典型的高龄肿瘤。因此,在所有西方国家中,筛查和如何筛查老年人的这些肿瘤是减少癌症总负担和死亡率的主要问题。乳腺癌(BC):乳腺癌的年龄相关风险从30岁时的1:25 00增加到80岁时的1:10。然而,大多数国家bc筛查项目在60岁或更早时停止。因此,大多数晚期(如T(4)期)BC发生在60岁以上的女性。通常认为,年龄相关的合并症应该消除治疗的好处。最近的两项纵向研究清楚地表明,正确的标准治疗对老年人和年轻人同样有效。乳房x光检查(MG)已被证明可以显著降低BC的死亡率,在70岁以上的人群中,其特异性和敏感性效果最好。前列腺癌(PC):前列腺癌的筛查情况与BC有很大不同,因为前列腺癌的风险特征定义不清,根治性前列腺切除术的益处在前列腺癌的早期无症状阶段没有明确显示。另一方面,警惕的等待也会导致尿失禁和遗尿的频率升高。目前正在进行的两项研究可能会改变这种情况;但最终结果预计最早要到2005-2008年。因此,辅助个人决策是目前唯一的建议。结直肠癌(CC):危险人群有明确的定义。老年人(> 60岁)的风险为平均风险。发病率从< 50/10(5)增加到75岁以上的500(男性)和500(女性)。何时开始筛查,何时停止筛查?专家建议从50岁开始,到80岁结束;但这并不是基于证据的。有几个未解决的问题和悬而未决的问题:我们没有确切地了解结肠镜检查在筛查过程中的并发症发生率。钡灌肠、虚拟结肠镜和遗传粪便检查与结肠镜联合粪便潜血检查(FOBT)的准确性比较缺乏数据。在知情的患者中,对筛查的依从性没有很好的记录。然而,cc筛查(单独FOBT或与结肠镜检查联合)的有效性已在三个高度随机试验中得到证实,这些试验显示,在8-13年期间,疾病特异性死亡率降低了15- 33%。但是必须明确的是,必须单独或通过保险来调动经济资源:仅向一千人提供十年的FOBT测试可以挽救一条生命。
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[Chances and risks of prevention in elderly people for the three major cancers: breast-, prostate- and colorectal cancers].

The big three, breast cancer (BC), prostate cancer (PC) and colorectal carcinoma are the most frequent malignancies world wide and also typical tumors of advanced age. Therefore the question to screen and how to screen for these tumors in the elderly is the main question for reduction of the total cancer burden and mortality in all western countries. BREAST CANCER (BC): The age related risk of BC increases from 1 : 2,500 at age 30+ to > 1 : 10 at age 80. Nevertheless, most of the national BC-Screening-Programs stop at age 60 or earlier. Therefore the majority of all advanced i. e. T (4) stages of BC are found in women age > 60. Frequently it is suggested that age related comorbidity should eliminate the benefit of treatment. Recently two longitudinal studies have clearly shown that correct standard treatment is as effective in elderly as in younger individuals. Mammography (MG) has been shown to reduce mortality of BC significantly with best results for specificity and sensitivity at age 70+. PROSTATE CANCER (PC): The screening situation of PC is quite different to BC, because risk profiles are poorly defined and the benefit of radical prostatectomy is not clearly demonstrated in the early non symptomatic stages of PC. At the other side watchful waiting leads to an elevated frequency of incontinence and enuresis as well. Two studies are now under progress and may possibly change the situation; but the final results are expected 2005-2008 at the earliest. Therefore an assisted individual decision making is the only recommendation at this time. COLORECTAL CANCER (CC): Risk groups are clearly defined. Risk of the elderly (> 60) is the average risk. The incidence increases from < 50/10 (5) to more than 500 at age 75+(male) and 500 (female). When to start and when to stop screening? Experts give the advice to begin at age 50 and to end at age 80; but this is not really evidence based. There are several unanswered questions and open problems: we are not exactly informed about complication rates of colonoscopy during the screening programs. There is a lack of data according accuracy of barium enema, virtual colonoscopy and genetic stool test in comparison to colonoscopy in combination with fecal occult blood test (FOBT). And adherence to screening is not well documented among informed patients. However, effectiveness of CC-screening (FOBT alone or in combination with colonoscopy) has been documented in three high randomised trials which have shown a disease specific mortality reduction of 15-33 % over a period of 8-13 years. But it must be clear that the economic resources must be mobilised individually or by insurance: offering the testing of only FOBT for ten years to one thousand persons can save one life.

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