Several Asian countries are implementing nationwide cancer screening programs.
Assessment of the effectiveness of these programs is critical to their success as this is the only way to ensure that the benefits of screening outweigh the harms. In this paper we focus on colorectal cancer (CRC) screening to illustrate the principles of screening program assessment. The International Agency for Research on Cancer (IARC) has defined organized screening, distinguishing it from opportunistic screening.
The key advantage of organized screening is that it provides greater protection against the possible harms of screening. Since screening is a process, not simply a test, the effectiveness of a program depends on the quality of each step in the cancer screening process. The evaluation of long-term screening program outcomes (CRC incidence and mortality) will not be observable for many years, given the time it takes to plan, pilot and implement a program. However, early performance indicators of the impact of screening should be monitored to give an early indication whether the program is on track. The European Union (EU) has recommended a minimum dataset to be collected and reported regularly by a screening program. Using information from these data tables, early performance indicators can be generated (e.g., participation rate, proportion of screen-detected cancers that are early-stage).
Subsequently, modeling the natural history of the disease can be very helpful to estimate long-term outcomes, making use of these directly measured early performance indicators. Modeling can also be used to estimate the cost-effectiveness of a screening program and the potential impact of changes in policy, as illustrated by its recent use in the Netherlands to change the definition of a positive fecal immunochemical test (FIT) for the CRC screening program. Programs should consider modeling as an important component of screening program evaluation.
一些亚洲国家正在实施全国性的癌症筛查项目。
评估这些项目的有效性对它们的成功至关重要，因为这是确保筛查利大于弊的唯一途径。本文以结直肠癌(CRC)筛查为例，阐述了筛查方案评估的原则。国际癌症研究机构(IARC)定义了有组织的筛查，将其与机会性筛查区分开来。
有组织的筛查的主要优势是，它提供了更大的保护，防止筛查的可能危害。由于筛查是一个过程，而不是简单的测试，因此一个项目的有效性取决于癌症筛查过程中每一步的质量。考虑到计划、试点和实施一个项目需要的时间，对长期筛查项目结果(CRC发病率和死亡率)的评估将在许多年内无法观察到。但是，应该监测筛查影响的早期性能指标，以便早期显示该计划是否在正轨上。欧洲联盟(EU)建议通过筛选程序定期收集和报告最低限度的数据集。利用这些数据表中的信息，可以生成早期性能指标(例如，参与率、早期筛查发现癌症的比例)。
随后，利用这些直接测量的早期性能指标，对疾病的自然历史建模可以非常有助于评估长期结果。模型还可用于评估筛查计划的成本效益和政策变化的潜在影响，荷兰最近使用模型对CRC筛查计划的粪便免疫化学阳性试验(FIT)的定义进行了更改，这一点可以说明这一点。程序应将建模作为筛选程序评估的重要组成部分。
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Assessment of a cancer screening program