Recently, a 2001 Cochrane Collaboration review of the same trials concluded that
six of the eight trials were "flawed" or of "poor quality" and that the pooled results from the remaining two better trials did not support a benefit from mammography.
• They concluded that
“screening for breast cancer with
mammography is unjustified”
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The US Preventive Services Task Force reviewed the same set of trials
一、 概 述
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什么是循证医学
•Evidence-based medicine (EBM)
•循证医学是在对个体病人制定临床 决策时应基于当前最佳的科学研究 成果。
•循证医学是最佳的证据、临床经验 和病人价值的有机结合。
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– Two were of medium quality, and the rest were poor quality or flawed.
• When the results of the two medium quality trials were combined, the risk ratio was 1.00 (95% CI 0.96, 1.05)
• the summary relative risk (RR) of breast cancer death among women randomized to screening in seven trials that included women older than 50 was 0.77 (95 percent CI, 0.67-0.89).
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什么是循证医学
利用发表的文献证据解决临床问 题对证据进行严格分级,提供指导对医 学文献评价分级的实践指南,并充分考 虑病人的需求和意愿解决具体临床问 题。
但这绝非否认从古至今传统决策 中亦在部分使用上述方法。
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• Their meta-analysis revealed that the overall risk of lung cancer among lifelong non-smoking women was 1.24 times higher when their husbands smoked, as compared to those women whose husbands did not smoke.
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• The meta-analysis performed for the USPSTF on the most current published data found that the pooled effect size of the combined trials was sizable and statistically significant:
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Hackshaw et al. conducted a very comprehensive systematic review in 1997
• They identified 37 published studies that reported risk of lung cancer among lifelong non-smoking women according to the husband’s smoking status
• They identified 8 large RCTs on this topic, with over 182,000 women randomized
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• The authors found that no trial data were of high quality
பைடு நூலகம்
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被动吸烟的危害
• A topic of great debate and controversy for many years
• First few epidemiologic studies were published in 1918
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用X线进行乳腺癌筛查 Mammography for breast cancer is an established screening method
• Is screening with mammography justifiable?
• Gotzsche & Olsen [Nordic Cochrane Centre] conducted a systematic review in 2000 and updated it in 2001.
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• The USPSTF recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older.