目前的檢查手段，并不能有效降低卵巢癌的死亡率

Tests commonly recommended to screen healthy women for ovarian cancer do more harm than good and should not be performed, a panel of medical experts said.

一個醫(yī)學(xué)專家小組稱，通常推薦的健康女性卵巢癌篩查弊大于利，不應(yīng)進(jìn)行這樣的檢查。

The screenings — blood tests for a substance linked to cancer, and ultrasound scans to examine the ovaries — do not lower the death rate from the disease, and yield many false-positive results that lead to unnecessary operations with high complication rates, the panel said.

專家小組表示，這項篩查(通過驗(yàn)血檢測一種腫瘤標(biāo)志物，以及通過超聲波掃描檢查卵巢)并未降低卵巢癌的死亡率，而且很多檢查結(jié)果是假陽性的，這導(dǎo)致患者接受不必要的手術(shù)，而且手術(shù)的并發(fā)癥發(fā)生率很高。

The advice against testing applies only to healthy women with an average risk of ovarian cancer, not to those with suspicious symptoms and not to women at high risk because they carry certain genetic mutations or have a family history of the disease.

反對檢查的建議，只適用于具有一般卵巢癌風(fēng)險的健康女性，而不適用于那些帶有可疑癥狀、或有高卵巢癌風(fēng)險(因?yàn)樗齻償y帶了某些基因突變、或有家族病史)的女性。

The recommendations against screening for ovarian cancer are being published on Monday in Annals of Internal Medicine. The warning is not new — the panel is reaffirming its own earlier advice. And though the task force has sometimes drawn fire in the past, particularly with its stand on mammograms, in this case it has plenty of support. Other medical groups, including the American Cancer Society and the American Congress of Obstetricians and Gynecologists, have for years been discouraging tests to screen for ovarian cancer.

反對卵巢癌篩查的建議發(fā)表在周一的《內(nèi)科醫(yī)學(xué)年鑒》(Annals of Internal Medicine)上。這個警告并不新;該小組只是在重申其早先的建議。盡管這個工作組曾在過去招致批評，尤其是它在乳房X光檢查上的立場，但它在卵巢癌篩查問題上得到廣泛支持。其他醫(yī)學(xué)組織，包括美國癌癥協(xié)會(American Cancer Society)和美國婦產(chǎn)科醫(yī)師學(xué)會(ACOG)，多年來一直反對卵巢癌篩查。

But some doctors continue to recommend screening anyway, and patients request it, clinging to the mistaken belief that the tests can somehow find the disease early enough to save lives. A report published in February in Annals of Internal Medicine, based on a survey of 1,088 doctors, said that about a third of them believed the screening was effective and that many routinely offered it to patients.

但是，一些醫(yī)生還是繼續(xù)推薦進(jìn)行這項篩查，患者也有這樣的要求，錯誤地相信檢查能及早發(fā)現(xiàn)疾病，挽救生命。《內(nèi)科醫(yī)學(xué)年鑒》今年2月發(fā)表了涉及1088名醫(yī)生的調(diào)查報告。報告稱，約有三分之一的醫(yī)生相信篩查是有效的，而且許多醫(yī)生經(jīng)常向患者推薦篩查。

Ovarian cancer is among the more rapidly fatal forms of cancer. In most cases, it is already advanced by the time it is diagnosed. Doctors say the only advice they can give women is not to ignore symptoms that may be the first warning of the disease: persistent bloating, pelvic or abdominal pain, feeling full early while eating and needing to urinate frequently.

卵巢癌是較快致命的癌癥之一。在大多數(shù)病例中，得到確診的患者已處于癌癥晚期。醫(yī)生們說，他們能給女性提供的唯一建議就是，不要忽視那些可能是卵巢癌最初警告的癥狀：持續(xù)腹脹、骨盆或腹部疼痛、進(jìn)食時很快就有飽脹感，以及需要頻繁小便。

For its latest recommendations, the panel relied heavily on a large study published last year in The Journal of the American American Medical Association of 78,216 women from 55 to 74. Half got screening and half did not, and they were followed for 11 to 13 years. The screening consisted of ultrasound exams and blood tests for elevated levels of substance called CA-125, which can be a sign of ovarian cancer.

該小組的最新建議在很大程度上依賴去年發(fā)表在《美國醫(yī)學(xué)協(xié)會期刊》(JAMA)上的一項大規(guī)模研究，該研究的對象是78216名年齡在55歲和74歲之間的女性，其中一半人接受篩查，而另一半人不接受篩查，對她們跟蹤研究11年到13年。篩查包括超聲波檢查和驗(yàn)血(檢測血液中CA-125的水平是否偏高，這可能是卵巢癌的標(biāo)志)。

There was no advantage to screening: the death rate from ovarian cancer was the same in the two groups. But among the women who were screened, nearly 10 percent — 3,285 women — had false positive results. Of those women with false positives, 1,080 had surgery, usually to remove one or both ovaries. Only after the operations were done was it clear that they had been unnecessary. And at least 15 percent of the women who had surgery had at least one serious complication, like blood clots, infections or surgical injuries to other organs.

篩查并未帶來優(yōu)勢：兩組研究對象的卵巢癌死亡率相同。但在接受篩查的女性中，有將近10%(即3285名女性)的人得到假陽性的檢查結(jié)果，其中1080人接受了手術(shù)，通常是摘除一側(cè)或雙側(cè)的卵巢。只是在手術(shù)完成后才發(fā)現(xiàn)手術(shù)并無必要。而且在接受手術(shù)的女性中至少有15%出現(xiàn)了至少一種嚴(yán)重并發(fā)癥，像血栓、感染，或其他器官受到手術(shù)損傷。

Dr. Barbara A. Goff, a gynecologic oncologist at the Fred Hutchinson Cancer Research Center in Seattle, said: “If patients request it, then I think a lot of times physicians feel it’s just easier to order the test, particularly if it’s covered by insurance, rather than taking the time to explain why it may not be good, that it could lead to inappropriate surgery, could lead to harm. I don’t think they think through the consequences.”

西雅圖弗雷德哈欽森癌癥研究中心(Fred Hutchinson Cancer Research Center)的婦科腫瘤專家芭芭拉·A·戈夫(Barbara A. Goff)說：“如果患者要求檢查，我認(rèn)為醫(yī)生在很多時候會覺得，與其花時間向患者解釋為什么檢查可能不好，可能導(dǎo)致不合適的手術(shù)并造成傷害，不如安排檢查更容易，尤其是在檢查在保險覆蓋范圍內(nèi)的情況下，我覺得他們沒有全面思考后果。”

It is often easier, she said, to talk patients into surgery than to talk them out of an operation or test they have set their minds on.

她說，與勸說已經(jīng)下定決心做手術(shù)或檢查的患者放棄相比，勸說患者接受手術(shù)往往更容易。

Dr. Edward E. Partridge, director of the cancer center at the University of Alabama, Birmingham, said that even if the testing could be improved to reduce false positives, it still would not save women’s lives. Even with the false positives eliminated, the fact remains that the death rate from the cancer was the same whether women were screened or not, suggesting that the test simply could not find the cancer early enough to make a difference.

伯明翰阿拉巴馬大學(xué)(University of Alabama, Birmingham)癌癥中心主任愛德華·E·帕特里奇(Edward E. Partridge)醫(yī)生說，即使可以通過改進(jìn)檢查來減少假陽性結(jié)果，也不會挽救女性的生命。即使消除假陽性結(jié)果，事實(shí)還是一樣，即無論女性是否接受篩查，卵巢癌的死亡率是相同的，這似乎表明，這些檢查不能足夠早地發(fā)現(xiàn)這種癌癥，不足以改變患者命運(yùn)。

Dr. Partridge said: “I think it’s really important that both the physician and the public really learn and assimilate that this test as it’s currently delivered is not effective at reducing death rates from ovarian cancer. We’ve got to find something else.”

帕特里奇醫(yī)生說：“我覺得真正重要的是，醫(yī)生和公眾都應(yīng)該知道并理解，目前實(shí)施的檢查手段并不能有效降低卵巢癌的死亡率。我們需要尋找其他的方法。”