好英语网健康女性卵巢癌筛查弊大于利
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 on Monday.
本周一，一个医学专家小组称，通常推荐的健康女性卵巢癌筛查弊大于利，不应进行这样的检查。
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.
专家小组表示，这项筛查（通过验血检测一种肿瘤标志物，以及通过超声波扫描检查卵巢）并未降低卵巢癌的死亡率，而且很多检查结果是假阳性的，这导致患者接受不必要的手术，而且手术的并发症发生率很高。
“There is no existing method of screening for ovarian cancer that is effective in reducing deaths,” Dr. Virginia Moyer, the chairwoman of the expert panel, said in a statement from the group, the United States Preventive Services Task Force. “In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery.”
“目前没有哪种筛查卵巢癌的方法在减少死亡率方面是有效的，”该医学专家小组——美国预防服务工作组(United States Preventive Services Task Force)主席、弗吉尼亚·莫耶(Virginia Moyer)医生在一份声明中表示，“实际上，接受筛查的女性中，有相当高比例得到假阳性的检查结果，最终可能承受不必要的伤害，比如大手术。”
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.
反对检查的建议，只适用于具有一般卵巢癌风险的健康女性，而不适用于那些带有可疑症状、或有高卵巢癌风险（因为她们携带了某些基因突变、或有家族病史）的女性。
The recommendations are just the latest in a series of challenges to cancer screening issued by the group, which has also rejected PSA screening for prostate cancer in men and routine mammograms in women under 50. The task force is a group of 16 experts, appointed by the government but independent, that makes recommendations about screening tests and other efforts to prevent disease. Its advice is based on medical evidence, not cost.
这是该小组发布的反对癌症筛查的一系列建议中的最新建议。此前该小组曾反对男性接受前列腺癌特异性抗原(PSA)筛查，以及50岁以下女性接受例行乳房X光检查。这个工作组由政府任命（但保持独立）的16名专家组成，负责为筛查检测和其他疾病预防工作提供建议。其建议建立在医学证据（而非成本）的基础上。
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.
反对卵巢癌筛查的建议发表在周一的《内科医学年鉴》(Annals of Internal Medicine)上。这个警告并不新；该小组只是在重申其早先的建议。尽管这个工作组曾在过去招致批评，尤其是它在乳房X光检查上的立场，但它在卵巢癌筛查问题上得到广泛支持。其他医学组织，包括美国癌症协会(American Cancer Society)和美国妇产科医师学会(ACOG)，多年来一直反对卵巢癌筛查。
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，一些医生还是继续推荐进行这项筛查，患者也有这样的要求，错误地相信检查能及早发现疾病，挽救生命。《内科医学年鉴》今年2月发表了涉及1088名医生的调查报告。报告称，约有三分之一的医生相信筛查是有效的，而且许多医生经常向患者推荐筛查。
“We are fueled by hope,” Dr. Moyer said.
“我们受到希望的驱使，”莫耶医生说道。
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.
卵巢癌是较快致命的癌症之一。在大多数病例中，得到确诊的患者已处于癌症晚期。医生们说，他们能给女性提供的唯一建议就是，不要忽视那些可能是卵巢癌最初警告的症状：持续腹胀、骨盆或腹部疼痛、进食时很快就有饱胀感，以及需要频繁小便。
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.
该小组的最新建议在很大程度上依赖去年发表在《美国医学协会期刊》(JAMA)上的一项大规模研究，该研究的对象是78216名年龄在55岁和74岁之间的女性，其中一半人接受筛查，而另一半人不接受筛查，对她们跟踪研究11年到13年。筛查包括超声波检查和验血（检测血液中CA-125的水平是否偏高，这可能是卵巢癌的标志）。
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.
筛查并未带来优势：两组研究对象的卵巢癌死亡率相同。但在接受筛查的女性中，有将近10%（即3285名女性）的人得到假阳性的检查结果，其中1080人接受了手术，通常是摘除一侧或双侧的卵巢。只是在手术完成后才发现手术并无必要。而且在接受手术的女性中至少有15%出现了至少一种严重并发症，像血栓、感染，或其他器官受到手术损伤。
To find one case of ovarian cancer, 20 women had to undergo surgery.
在20名接受手术的女性中，只会发现一名卵巢癌患者。
The problem with the tests is that CA-125 can be elevated by conditions other than cancer, and ultrasound can reveal ovarian enlargement or cysts that are benign but that cannot distinguished from cancer without surgery to take out the ovary.
检查的问题是，癌症以外的其他病症也可能让CA-125的水平上升，超声波可能显示卵巢肥大或良性囊肿，但只有通过手术取出卵巢才能辨别是否是癌症。
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.”
西雅图弗雷德哈钦森癌症研究中心(Fred Hutchinson Cancer Research Center)的妇科肿瘤专家芭芭拉·A·戈夫(Barbara A. Goff)说：“如果患者要求检查，我认为医生在很多时候会觉得，与其花时间向患者解释为什么检查可能不好，可能导致不合适的手术并造成伤害，不如安排检查更容易，尤其是在检查在保险覆盖范围内的情况下，我觉得他们没有全面思考后果。”
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.
她说，与劝说已经下定决心做手术或检查的患者放弃相比，劝说患者接受手术往往更容易。
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.
伯明翰阿拉巴马大学(University of Alabama, Birmingham)癌症中心主任爱德华·E·帕特里奇(Edward E. Partridge)医生说，即使可以通过改进检查来减少假阳性结果，也不会挽救女性的生命。即使消除假阳性结果，事实还是一样，即无论女性是否接受筛查，卵巢癌的死亡率是相同的，这似乎表明，这些检查不能足够早地发现这种癌症，不足以改变患者命运。
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.”
帕特里奇医生说：“我觉得真正重要的是，医生和公众都应该知道并理解，目前实施的检查手段并不能有效降低卵巢癌的死亡率。我们需要寻找其他的方法。”