数字里的癌症

发自费城——与一个庞大的听众群体交流医学风险是一件相当艰难的事情,尤其是在官方建议与人们的情绪化描述相抵触的时候。而这也是美国预防医学工作组(USPSTF)在2009年所遇到的问题,当时该机构发布了其乳腺癌医学筛查指引,建议将原有的40岁以上无症状妇女每两年做一次筛查改为所有50岁以上的女性每年拍一张乳房X光片,结果却引发了公众的极大愤怒。

其实我们可以在数学和心理学之间的模糊区域中找到解读这一公众回应的关键点。人们对于上述发现的不满在很大程度上源自于一种错误的直觉:如果更早且更频密的筛查可以增加发现某种可致命癌症的几率,那么更多的筛查就是应该的。这么说来倘若更多的筛查可以在40岁年龄段的临床无症状妇女中发现乳腺癌,那何不把它提前到30岁?如果这也可行的话,按照逻辑上的归缪法,干脆从15岁开始每月照一张X光片好了。

很显然,如此频密的筛查只会弊大于利。而在此之间寻找一个合适的平衡点也是相当有难度的。其中最不幸的,莫过于我们知道连续多年进行X光照射会产生辐射累积效应,活体组织检查会对人体造成伤害,同时治疗那些缓慢生长且永远不会证明是恶性的肿瘤也将损害患者的健康,但这些因素相对于乳腺癌的危险性该如何权衡则并非易事。

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