Тезисы статьи: с 50-х в Европе, в основном, заболеваемость туберкулезом снизилась до менее 5 случаев на 100 тыс. Программа свернута в 70-е, в соответствии с рекомендациями ВОЗ. Примерные затраты на выявление 1 случая туберкулеза, путем флюорографического скрининга, порядка С$ 230000 (канадск. долларов) в группах с низким риском и С$ 3900 в группах с высоким (канадское исследование 2000 г.).
Флюорография по-прежнему простой и полезный способ для предотвращения передачи заболевания в определенных ситуациях, например, в местах лишения свободы, а также для иммиграционных заявителей и иностранных работников, прибывающих из стран с более высоким риском развития туберкулеза. В настоящее время 13 из 26 европейских стран используют флюорографию в качестве основного инструмента скрининга для этой цели. Примеры стран с постоянными программами являются Италия, Швейцария, Норвегия, Нидерланды, Япония и Соединенное Королевство.
Итак, как видно, в связи с потоком иммигрантов, флюорография в Европе местами целесообразна. У нас заболеваемость почти 60 случаев на 100 тыс, так что говорить о сворачивании программы, как бы нам этого не хотелось, рановато. Насколько мне известно, стоимость выявления одного случая ФГ-скринингом у нас в России порядка 300 тыс. руб.
Да, еще, если прямо отвечать на вопрос ТС - да, можно, если 50 лет и старше и курение более 20 пачко-лет. В противном случае неоправданные затраты и облучение.
Да, еще, если прямо отвечать на вопрос ТС - да, можно, если 50 лет и старше и курение более 20 пачко-лет. В противном случае неоправданные затраты и облучение.
Да фиг с ним с курением, главное СЕРОВ появился, а это не хухры-мухры, ЭТО СЕРОВ!
Да, еще, если прямо отвечать на вопрос ТС - да, можно, если 50 лет и старше и курение более 20 пачко-лет. В противном случае неоправданные затраты и облучение.
Да фиг с ним с курением, главное СЕРОВ появился, а это не хухры-мухры, ЭТО СЕРОВ!
Наверное.. Я тут ещё нашёл из того времени, извиняюсь за офтоп:
...сейчас школота хихикает... Ранее анашу ростили и для текстильной промышленноси включительно! Это потом уже запад и Афганистан ее покурили... Сейчас от бомжа до чиновника продолжают ее шмалить... Телки тоже хорошо! Сейчас проще из Австралийской кенгурятины делать колбасы, знаете ли из телок порой затратнее...)))
Сейчас проще из Австралийской кенгурятины делать колбасы, знаете ли из телок порой затратнее...)))
Вы не правы дорогой Евгений Алексеевич!
На селе до сих пор из свинки, из дикого кабанчика, из домашних кур уток. индюшек и кроликов весьма вкусную, неповторимую колбасу и тушонку делают. Я конечно колбасу не делал, а вот тушонку из своих кроликов постоянно делаю...,"тёлке" до этого далеко, а кунгуру и не допрыгнуть...
Сейчас проще из Австралийской кенгурятины делать колбасы, знаете ли из телок порой затратнее...)))
Вы не правы дорогой Евгений Алексеевич!
На селе до сих пор из свинки, из дикого кабанчика, из домашних кур уток. индюшек и кроликов весьма вкусную, неповторимую колбасу и тушонку делают. Я конечно колбасу не делал, а вот тушонку из своих кроликов постоянно делаю...,"тёлке" до этого далеко, а кунгуру и не допрыгнуть...
я технологом нашего местного комбинатика в близких... Знаю что говорю)
Lung Cancer Screening -- Benefits Few, May Harm Many
Implementing lung cancer screening with low-dose computed tomography (CT) for high-risk persons poses logistic challenges and the data for the outcomes reported suggest more harm than benefit, according to a population-based Veterans Health Administration (VHA) study, the Lung Cancer Screening Demonstration Project.
Conducted in more than 2000 high-risk VHA patients aged 55 to 80 years, the study found lung cancer in 1.5% of patients, but around 60% of individuals who were screened were positive for the test, including 1 or more nodules that needed to be tracked. Incidental findings were further reported in around 40% of patients. Moreover, the logistics of setting up the project provided inordinate challenges even for a well-oiled machine such as the VHA, the researchers said.
Dr Redberg said in an interview. "It is quite clear from this study that a substantial proportion of patients are harmed and many do not get the benefits," she added. "Indeed, we are learning more and more that early detection is not always better and that we detect things we do not need to worry about," Dr Redberg pointed out.
Dr Kinsinger explained in an interview that the VHA project was not designed to replicate the National Lung Screening Trial, which was the basis of the 2013 US Preventive Services Task Force (USPSTF) recommendation.
Rather, a proactive population-based approach actively sought out all eligible individuals based on the USPSTF recommendation, she elaborated. Indeed, following VHA policy, this project was not deemed to be research but was "declared nonresearch clinical operations activities."
The authors cite several drawbacks of a comprehensive lung cancer screening program, which included stressing the capacity of radiology services, increase in the workload of pulmonary services for nodules that needed follow-up, and the involvement of primary care in determining which incidental findings needed follow-up.
Quality assurance measures are also required for a successful screening program. In this study, the outcomes reported varied widely. The wide range of nodular findings (31% - 85%) may reflect differences in interpretation of participating radiologists. "Better standardization is required for consistency," Dr Kinsinger said. "Better guidelines for nodule follow-up are also needed," she added.
In their editorial, Dr Redberg and Dr O'Malley calculate that, based on the data reported, for every 1000 individuals who are screened, 10 will be diagnosed with early-stage lung cancer, 5 will be diagnosed with late-stage lung cancer, and 20 will undergo invasive procedures (bronchoscopy and thoracotomy) directly related to screening.
"It is very disturbing to know that more than 50% [550/1000] of patients will experience unnecessary alarm and repeat scans, with its associated irradiation," Dr Redberg told Medscape Medical News. "These are not good odds of benefit and this is likely the best data we'll get," she added.
Based on a separate report, also published online January 30, the editorialists point out that most lung cancer screening appears to be carried out in individuals who are not even eligible for such screening because they are low-risk individuals and never-smokers.
In April 2014, as a nonvoting member, Dr Redberg chaired the lung cancer screening discussion for Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) that recommended against low-dose CT for lung cancer screening. The reasons are highlighted in the editorial: harm from radiation if low-dose CT protocol was not followed, high rate of false-positives leading to potentially unnecessary invasive and risky procedures, high variability and low reproducibility of radiology readings for nodules, and higher morbidity and mortality from operative procedures.
Notably, on April 30, 2014, prior to the CMS coverage decision, the CMS advisory body—Medicare Evidence Development and Coverage Advisory Committee (MEDCAC)—had evaluated the use of low-dose computed tomography (CT) for LCS.3 MEDCAC’s mission is to provide independent guidance and expert advice to CMS. After reviewing the evidence and public testimony, the committee cast a vote of low confidence (2.22 on a 1-5 scale) that the benefits of LCS would exceed the harms for the Medicare population and expressed low confidence that the harms of screening would be minimized and high confidence (4.67) that evidence gaps remain.3
Discussion included concerns about (1) the harms of radiation from the CT screening process increasing cancer risk, particularly if the low-dose CT protocol was not followed; (2) the high rate of false positives (96%) found by the NLST; leading to (3) the potential for numerous additional invasive and risky procedures to investigate many noncancerous nodules; (4) high variability and low reproducibility of radiology readings of lung nodules; and (5) higher morbidity and mortality from operative procedures than the lower-than-average rates in the NLST.2 In addition, MEDCAC noted that although the NLST found a small mortality benefit for low-dose CT, 3 European trials had found no benefit of low-dose CT.4- 6 Furthermore, the NLST used chest radiography as a control, although chest radiography had already been shown to be associated with increased mortality compared with no imaging for LCS, raising the possibility that low-dose CT compared with no imaging would not show any outcomes benefits.
With this background, the article by Kinsinger et al7 gives us the first carefully performed evaluation of an LCS program, in the Veterans Affairs (VA) setting. The findings are fascinating: a low take-up of LCS (58%), a high rate of incidental findings (41%), a low rate of detection of lung cancer, and all for a highly resource-intensive program. From the data reported, we calculate that for every 1000 people screened, 10 will be diagnosed with early-stage lung cancer (potentially curable), and 5 with advanced-stage lung cancer (incurable); 20 will undergo unnecessary invasive procedures (bronchoscopy and thoracotomy) directly related to the screening; and 550 will experience unnecessary alarm and repeated CT scanning (with its associated irradiation).
Whether the benefits from this program outweigh the harms, and whether LCS is a wise investment of considerable resources required for screening and training, remains to be adequately evaluated with robust economic and utility analyses. In the meantime, it is critically important to limit screening to the patients most likely to benefit, in a fully informed, shared-decision manner; it is essential to fully evaluate the potential benefits and known harms before proceeding with lung cancer screening.
Moreover, the logistics of setting up the project provided inordinate challenges even for a well-oiled machine such as the VHA, the researchers said.
Посмотрим какие результаты будут у московских рентгенологов.
Я смотрю оффтоп пошел, для внесения конструктивности предлагаю ознакомиться со статьей из Википедии https://en.wikipedia.org/wiki/Chest_photofluorography .
Тезисы статьи: с 50-х в Европе, в основном, заболеваемость туберкулезом снизилась до менее 5 случаев на 100 тыс. Программа свернута в 70-е, в соответствии с рекомендациями ВОЗ. Примерные затраты на выявление 1 случая туберкулеза, путем флюорографического скрининга, порядка С$ 230000 (канадск. долларов) в группах с низким риском и С$ 3900 в группах с высоким (канадское исследование 2000 г.).
Флюорография по-прежнему простой и полезный способ для предотвращения передачи заболевания в определенных ситуациях, например, в местах лишения свободы, а также для иммиграционных заявителей и иностранных работников, прибывающих из стран с более высоким риском развития туберкулеза. В настоящее время 13 из 26 европейских стран используют флюорографию в качестве основного инструмента скрининга для этой цели. Примеры стран с постоянными программами являются Италия, Швейцария, Норвегия, Нидерланды, Япония и Соединенное Королевство.
Итак, как видно, в связи с потоком иммигрантов, флюорография в Европе местами целесообразна. У нас заболеваемость почти 60 случаев на 100 тыс, так что говорить о сворачивании программы, как бы нам этого не хотелось, рановато. Насколько мне известно, стоимость выявления одного случая ФГ-скринингом у нас в России порядка 300 тыс. руб.
Зри в корень!
Да, еще, если прямо отвечать на вопрос ТС - да, можно, если 50 лет и старше и курение более 20 пачко-лет. В противном случае неоправданные затраты и облучение.
Зри в корень!
Да фиг с ним с курением, главное СЕРОВ появился, а это не хухры-мухры, ЭТО СЕРОВ!
Здравствуйте уважаемый Владимир Борисович!
Вы не правы дорогой Евгений Алексеевич!
На селе до сих пор из свинки, из дикого кабанчика, из домашних кур уток. индюшек и кроликов весьма вкусную, неповторимую колбасу и тушонку делают. Я конечно колбасу не делал, а вот тушонку из своих кроликов постоянно делаю...,"тёлке" до этого далеко, а кунгуру и не допрыгнуть...
http://www.medscape.com/viewarticle/875091#vp_1
January 30, 2017
Lung Cancer Screening -- Benefits Few, May Harm Many
Implementing lung cancer screening with low-dose computed tomography (CT) for high-risk persons poses logistic challenges and the data for the outcomes reported suggest more harm than benefit, according to a population-based Veterans Health Administration (VHA) study, the Lung Cancer Screening Demonstration Project.
Conducted in more than 2000 high-risk VHA patients aged 55 to 80 years, the study found lung cancer in 1.5% of patients, but around 60% of individuals who were screened were positive for the test, including 1 or more nodules that needed to be tracked. Incidental findings were further reported in around 40% of patients. Moreover, the logistics of setting up the project provided inordinate challenges even for a well-oiled machine such as the VHA, the researchers said.
Dr Redberg said in an interview. "It is quite clear from this study that a substantial proportion of patients are harmed and many do not get the benefits," she added. "Indeed, we are learning more and more that early detection is not always better and that we detect things we do not need to worry about," Dr Redberg pointed out.
Dr Kinsinger explained in an interview that the VHA project was not designed to replicate the National Lung Screening Trial, which was the basis of the 2013 US Preventive Services Task Force (USPSTF) recommendation.
Rather, a proactive population-based approach actively sought out all eligible individuals based on the USPSTF recommendation, she elaborated. Indeed, following VHA policy, this project was not deemed to be research but was "declared nonresearch clinical operations activities."
The authors cite several drawbacks of a comprehensive lung cancer screening program, which included stressing the capacity of radiology services, increase in the workload of pulmonary services for nodules that needed follow-up, and the involvement of primary care in determining which incidental findings needed follow-up.
Quality assurance measures are also required for a successful screening program. In this study, the outcomes reported varied widely. The wide range of nodular findings (31% - 85%) may reflect differences in interpretation of participating radiologists. "Better standardization is required for consistency," Dr Kinsinger said. "Better guidelines for nodule follow-up are also needed," she added.
In their editorial, Dr Redberg and Dr O'Malley calculate that, based on the data reported, for every 1000 individuals who are screened, 10 will be diagnosed with early-stage lung cancer, 5 will be diagnosed with late-stage lung cancer, and 20 will undergo invasive procedures (bronchoscopy and thoracotomy) directly related to screening.
"It is very disturbing to know that more than 50% [550/1000] of patients will experience unnecessary alarm and repeat scans, with its associated irradiation," Dr Redberg told Medscape Medical News. "These are not good odds of benefit and this is likely the best data we'll get," she added.
Based on a separate report, also published online January 30, the editorialists point out that most lung cancer screening appears to be carried out in individuals who are not even eligible for such screening because they are low-risk individuals and never-smokers.
In April 2014, as a nonvoting member, Dr Redberg chaired the lung cancer screening discussion for Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) that recommended against low-dose CT for lung cancer screening. The reasons are highlighted in the editorial: harm from radiation if low-dose CT protocol was not followed, high rate of false-positives leading to potentially unnecessary invasive and risky procedures, high variability and low reproducibility of radiology readings for nodules, and higher morbidity and mortality from operative procedures.
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599435
Notably, on April 30, 2014, prior to the CMS coverage decision, the CMS advisory body—Medicare Evidence Development and Coverage Advisory Committee (MEDCAC)—had evaluated the use of low-dose computed tomography (CT) for LCS.3 MEDCAC’s mission is to provide independent guidance and expert advice to CMS. After reviewing the evidence and public testimony, the committee cast a vote of low confidence (2.22 on a 1-5 scale) that the benefits of LCS would exceed the harms for the Medicare population and expressed low confidence that the harms of screening would be minimized and high confidence (4.67) that evidence gaps remain.3
Discussion included concerns about (1) the harms of radiation from the CT screening process increasing cancer risk, particularly if the low-dose CT protocol was not followed; (2) the high rate of false positives (96%) found by the NLST; leading to (3) the potential for numerous additional invasive and risky procedures to investigate many noncancerous nodules; (4) high variability and low reproducibility of radiology readings of lung nodules; and (5) higher morbidity and mortality from operative procedures than the lower-than-average rates in the NLST.2 In addition, MEDCAC noted that although the NLST found a small mortality benefit for low-dose CT, 3 European trials had found no benefit of low-dose CT.4- 6 Furthermore, the NLST used chest radiography as a control, although chest radiography had already been shown to be associated with increased mortality compared with no imaging for LCS, raising the possibility that low-dose CT compared with no imaging would not show any outcomes benefits.
With this background, the article by Kinsinger et al7 gives us the first carefully performed evaluation of an LCS program, in the Veterans Affairs (VA) setting. The findings are fascinating: a low take-up of LCS (58%), a high rate of incidental findings (41%), a low rate of detection of lung cancer, and all for a highly resource-intensive program. From the data reported, we calculate that for every 1000 people screened, 10 will be diagnosed with early-stage lung cancer (potentially curable), and 5 with advanced-stage lung cancer (incurable); 20 will undergo unnecessary invasive procedures (bronchoscopy and thoracotomy) directly related to the screening; and 550 will experience unnecessary alarm and repeated CT scanning (with its associated irradiation).
Whether the benefits from this program outweigh the harms, and whether LCS is a wise investment of considerable resources required for screening and training, remains to be adequately evaluated with robust economic and utility analyses. In the meantime, it is critically important to limit screening to the patients most likely to benefit, in a fully informed, shared-decision manner; it is essential to fully evaluate the potential benefits and known harms before proceeding with lung cancer screening.
Moreover, the logistics of setting up the project provided inordinate challenges even for a well-oiled machine such as the VHA, the researchers said.
Посмотрим какие результаты будут у московских рентгенологов.