日航太郎の飛行機搭乗日記

日航太郎と申します 今日もしゅっ、しゅぎょうしています

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原著があった

取りあえず昨日書いた検診の統計学的な記述に関する原著が残っていたので簡単な概略だけでも書いておきます。

* Mayo Lung Study(Cancer,67: 1155, 1991)

The National Cancer Institute of the United States recently sponsored three large-scale, randomized controlled trials of screening for early lung cancer. The trials were conducted at the Johns Hopkins Medical Institutions, the Memorial Sloan-Kettering Cancer Center, and the Mayo Clinic. Participants were middle-aged and older men who were chronic heavy cigarette smokers and thus at high risk of developing lung cancer. Screening procedures were chest radiography and sputum cytology, the only screening tests of established value for detecting early stage, asymptomatic lung cancer. In the Hopkins and Memorial trials the study population was offered yearly chest radiography plus sputum cytology every 4 months. The control population was offered yearly chest radiography only. In these trials the addition of sputum cytology appeared to confer no lung cancer mortality rate advantage. The Mayo Clinic trial compared offering chest radiography and sputum cytology every 4 months to offering advice that the two tests be obtained once a year. This trial demonstrated significantly increased lung cancer detection, resectability, and survivorship in the group offered screening every 4 months compared with the control group. However, there was no significant difference in lung cancer mortality rate between the two groups. The statistical power of these trials was somewhat limited. Nevertheless, results do not justify recommending large-scale radiologic or cytologic screening for early lung cancer at this time.

(1) 45歳以上で一日20本以上の喫煙者が対象。9221人を無作為に2群に分けた。
(2) 検診群(胸部X線+喀痰細胞診を年3回)は4618人、対照群(何もしない放置プレイ)は4593人。
(3) 発見肺癌数は、検診群206人、対照群160人。
(4) 対1000人あたりの肺癌死亡は検診群3.2人、対照群3.0人で有意差なし。



* Malmo・study(乳癌検診のRCT、BMJ, 297:943, 1988)おまけ

STUDY OBJECTIVE--To determine whether mortality from breast cancer could be reduced by repeated mammographic screening. DESIGN--Birth year cohorts of city population separately randomised into study and control groups. SETTING--Screening clinic outside main hospital. PATIENTS--Women aged over 45; 21,088 invited for screening and 21,195 in control group. INTERVENTIONS--Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis. END POINT--Mortality from breast cancer. MEASUREMENTS AND MAIN RESULTS--All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8.8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0.96 (95% confidence interval 0.68 to 1.35)). In the study group 29% more women aged less than 55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged greater than or equal to 55 at entry. Overall, women in the study group aged greater than or equal to 55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0.79 (0.51 to 1.24)). OTHER FINDINGS--In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group. CONCLUSIONS--Invitation to mammographic screening may lead to reduced mortality from breast cancer, at least in women aged 55 or over.


(1) 乳癌好発年齢の女性42000人を無作為に2群に分けた。10年間追跡。
(2) 乳癌死亡実数はマンモグラフィー検診群で63人、対照群で66人(有意差無し)。1000人あたりの乳癌死亡数はマンモグラフィー検診群で3.0人、対照群で3.1人(もちろん有意差無し)。
(3) 総死亡(乳癌だけでなくいろんな原因で死んだ人全てを含む)は、マンモグラフィー検診群で1777人(1000人あたり84.3人)、対照群1819人(1000人あたり85.4人)で有意差なし。


*Minnesota study(大腸癌検診のRCT、NEJM, 328: 1365, 1993)おまけ

BACKGROUND. Although tests for occult blood in the feces are widely used to screen for colorectal cancers, there is no conclusive evidence that they reduce mortality from this cause. We evaluated a fecal occult-blood test in a randomized trial and documented its effectiveness. METHODS. We randomly assigned 46,551 participants 50 to 80 years of age to screening for colorectal cancer once a year, to screening every two years, or to a control group. Participants who were screened submitted six guaiac-impregnated paper slides with two smears from each of three consecutive stools. About 83 percent of the slides were rehydrated. Participants who tested positive underwent a diagnostic evaluation that included colonoscopy. Vital status was ascertained for all study participants during 13 years of follow-up. A committee determined causes of death. A single pathologist determined the stage of each tissue specimen. Differences in mortality from colorectal cancer, the primary study end point, were monitored with the sequential log-rank statistic. RESULTS. The 13-year cumulative mortality per 1000 from colorectal cancer was 5.88 in the annually screened group (95 percent confidence interval, 4.61 to 7.15), 8.33 in the biennially screened group (95 percent confidence interval, 6.82 to 9.84), and 8.83 in the control group (95 percent confidence interval, 7.26 to 10.40). The rate in the annually screened group, but not in the biennially screened group, was significantly lower than that in the control group. Reduced mortality in the annually screened group was accompanied by improved survival in those with colorectal cancer and a shift to detection at an earlier stage of cancer. CONCLUSIONS. Annual fecal occult-blood testing with rehydration of the samples decreased the 13-year cumulative mortality from colorectal cancer by 33 percent.


(1) 50歳から80歳の46000人を無作為に3群に分け、13年以上追跡。
(2) A群(便潜血検査を毎年実施)、B群(便潜血検査を2年ごとに実施)、C群(放置プレイの対照群)。
(3) 大腸癌による死亡(1000人あたり)は、A群5.9人、B群8.3人、C群8.8人。
(4) 総死亡(大腸癌だけでなく、いろんな原因で死んだ人全て)は1000人あたり、A群216人、B群218人、C群216人。

ちなみに上記の論文、

Annual fecal occult-blood testing with rehydration of the samples decreased the 13-year cumulative mortality from colorectal cancer by 33 percent.

と結論を出しています。
つまり、毎年便潜血の検診を受けると大腸癌による死亡が33%減ると(A群5.9人、C群8.8人)。
でも総死亡は変わらないので、寿命には影響無しということになります(都合の良いところだけ強調する典型的な論文)。



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日航太郎

Author:日航太郎
日航太郎と申します。
今日もしゅ、しゅぎょうしています。
以前の日記は http://blogs.yahoo.co.jp/jal_jgp へ
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