Biases in Studies of Screening Programs在筛选程序研究的偏见.pptVIP

* * * * * * * * * * * MLP Extended Follow-up Results* Intervention group: slight increase in lung-cancer mortality (P=0.09 by 1996) *Marcus et al., JNCI 2000;92:1308-16 What happened? After 20 years of follow up, there was a significant increase (29%) in the total number of lung cancers in the screened group Excess of tumors in early stage No decrease in late stage tumors Overdiagnosis (pseudodisease) Black W. Overdiagnosis: an underrecognized cause of confusion and harm in cancer screening. JNCI 2000;92:1308-16 Looking for Pseudodisease Appreciate the varying natural history of disease, a