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当初级保健医生实施专科医生制定的筛查指南时,两者可能因视角不同而产生分歧。两则由专科机构最近发布的临床指南就足以说明这一问题。美国泌尿学会(AUA)指南小组和美国国家综合癌症网络(NCCN)建议,具有前列腺癌一般患病风险的男性在40岁对前列腺特异性抗原筛查风险和好处进行咨询,而此前建议的年龄是50岁。不过,目前没有直接证据证明此建议对前列腺癌死亡率有具体影响。为了不妨碍初级保健医生为患者提供好处和价值已被证实的服务,专业机构在制定指南时应遵循适当的标准。初级保健协会和医疗系统也应该对现有证据进行评估,以判断临床建议实施的可行性和适用性。
When primary care physicians practice screening guidelines developed by specialists, the two may diverge from each other due to different perspectives. Two recent clinical guidelines issued by specialized agencies are sufficient to illustrate this issue. The AUA guidelines group and the National Comprehensive Cancer Network (NCCN) suggest that men with a general risk of prostate cancer at age 40 consult on the risk and benefit of prostate-specific antigen screening, whereas the previously recommended age was 50 years old. However, there is currently no direct evidence that this recommendation has a specific impact on the mortality of prostate cancer. In order not to hinder the primary care physicians from providing benefits and worthwhile services to patients, specialized agencies should follow appropriate standards when developing guidelines. Primary care associations and the health care system should also evaluate available evidence to determine the feasibility and applicability of clinical recommendations.