Precision screening for lung cancer : Risk-based but not always preference-sensitive ?
Menée à partir d'une microsimulation intégrant des données issues de deux grands essais cliniques, d'analyses décisionnelles et des registres américains des cancers, cette étude analyse l'effet de différentes préférences en matière de critères d'éligibilité sur l'efficacité d'un programme annuel de dépistage du cancer du poumon par tomographie numérique à faibles doses de rayonnements
In lung cancer screening circles, one of the most hotly debated questions is whom to screen. As with many controversies, this one is about values and there is no single correct answer. The debate includes arguments from at least 4 camps, and each has merit. The “efficiency maximizers” believe that screening should be restricted to patients at the highest risk for lung cancer death to minimize waste and maximize the ratio of benefits to harms. In contrast, the goal of the “benefit maximizers” is to prevent as many deaths from lung cancer as possible, which leads them to favor liberal eligibility criteria and screening of persons at lower risk. Another camp is represented by the “evidence-based medicine purists,” who would limit screening to persons meeting eligibility criteria for the NLST (National Lung Screening Trial), for whom we have the most direct evidence of a net benefit of screening with low-dose computed tomography (LDCT). Finally, the “libertarians” defer to the preferences of well-informed patients, regardless of underlying risk or efficiency.
Annals of Internal Medicine , éditorial, 2017