简介:癌症在美国引起显著的发病率和死亡率。它是美国第二大常见死因,心脏病之后。非洲裔美国人受恶性肿瘤的影响不成比例,与其他种族和族裔群体相比,总体死亡率更高。筛查测试可以识别早期恶性肿瘤,以便及时干预。然而,非洲裔美国人很少接受癌症筛查。基因组技术的进步导致了血液中癌症信号的识别。这导致了评估循环无细胞DNA(cfDNA)的多癌早期检测(MCED)测试的发展。这项研究评估了医生对使用多癌早期检测测试(MCED)的看法。
方法:匿名,对非裔美国人/黑人医生和医学生进行了29个问题调查。调查参与者是通过国家医学协会和其他主要包括非裔美国医生的专业组织确定的。如果受访者是非非洲裔美国人/黑人或非医师或医学生,则调查被排除在分析之外。调查收集了医生的人口统计数据,非洲裔美国人/黑人患者的比例,患者筛查的障碍,MCED测试的潜在用途和影响推荐测试决定的因素。生成描述性统计数据。使用卡方进行另外的分析,统计学显著性设定为p值<0.05。该调查经过了信度和效度的初步测试。
结果:1196(681名女性,515名男性)医生和医学生完成了调查。95.8%是曾经或曾经在临床实践中的医生。53%的医生报告说,他们的患者中有40%以上是非裔美国人/黑人。癌症筛查的障碍包括对重要性缺乏了解(33.8%),缺乏或有限的保险范围(23.5%),与保险范围无关的社会经济因素(16.2%),对癌症的恐惧(8.8%),医疗保健系统中种族主义和偏见的历史(7.4%),8.8%的人报告“其他”,1.5%的人报告没有感知到的障碍。与其他患者相比,医生认为医疗保健系统中的种族主义和偏见是非裔美国人/黑人患者癌症筛查的障碍,这一比率存在显着差异(p<0.03)。大多数医生和医学生表示,MCED测试将使所有患者受益(86.8%),将鼓励进一步的癌症筛查测试(83.8%),无论社会经济或医疗保健机会如何(83.8%),对少数群体和代表性不足的患者都是有益的。75%的调查受访者表示,MCED测试将有利于促进非洲裔美国人/黑人患者的进一步癌症筛查和早期发现。影响MCED测试顺序的因素包括科学证据和测试有效性(63.2%),效率,可访问性,易于订购和易于接收结果(11.8%),保险覆盖率(13.2%)和“其他因素”(11.8%)。
结论:这是评估医生对MCED测试看法的最大调查之一,也是第一个评估非裔美国医生观点的研究。它提供了有关医生接受和将MCED纳入临床实践的见解。重要的是,采用多方面的方法来改善癌症预后并减少生存差异。MCED测试,基因组技术的一个相对较新的进步,有可能成为癌症筛查策略的重要组成部分。
INTRODUCTION: Cancer causes significant morbidity and mortality in the United States. It is the second most common cause of death in the United States, after heart disease. African Americans are disproportionately affected by malignancy, with overall higher death rates compared to other racial and ethnic groups. Screening tests can identify early stage malignancy allowing for timely intervention. However, African Americans less frequently undergo cancer screening. Advancement in genomic technology has led to the identification of signals for cancer in the blood. This has resulted in the development of multi-cancer early detection (
MCED) tests which evaluate for circulating cell-free DNA (cfDNA). This study evaluated physicians\' perception of the use of a multi-cancer early detection test (
MCED).
METHODS: An anonymous, 29 question survey was administered to African American / Black physicians and medical students. Survey participants were identified through the National Medical Association and other professional organizations that included primarily African American physicians. Surveys were excluded from analysis if respondent was non-African American / Black or was not a physician or medical student. The survey collected physician demographics, percentage of African American / Black patients in their practice, patient barriers to screening, potential use of MCED tests and factors influencing decision to recommend testing. Descriptive statistics were generated. Additional analysis was performed using Chi-Square with statistical significance set at p-value <0.05. The survey was pilot tested for reliability and validity.
RESULTS: 1196 (681 female, 515 male) physicians and medical students completed the survey. 95.8 % were physicians who were or had been in clinical practice. Fifty-three percent of physicians reported that >40 % of their patients were African American / Black. Barriers to cancer screening included lack of understanding of the importance (33.8 %), lack of or limited insurance coverage (23.5 %), socioeconomic factors unrelated to insurance coverage (16.2 %), fear of cancer (8.8 %), history of racism and bias in the health care system (7.4 %) with 8.8 % reporting \'other\' and 1.5 % reporting no perceived barriers. There was a significant difference (p<0.03) in the rate that physicians\' perceived racism and bias in the health care system as barrier for cancer screening in African American / Black patients when compared to other patients. Most physicians and medical students indicated that a
MCED test would benefit all patients (86.8 %), would encourage further cancer screening tests (83.8 %), and would be beneficial for minority and under-represented patients regardless of socioeconomics or health care access (83.8 %). Seventy-five percent of survey respondents indicated that a MCED test would be beneficial in promoting further cancer screening and early detection in African American / Black patients. Factors that would impact the ordering of an
MCED test included scientific evidence and test validity (63.2 %), efficiency, accessibility, ease of ordering and ease of receiving results (11.8 %), insurance coverage (13.2 %) and \'other factors\' (11.8 %).
CONCLUSIONS: This is one of the largest surveys to assess physicians\' perceptions about MCED testing and is the first study to evaluate the perspectives of African American physicians. It offers insight about physician acceptance and potential incorporation of MCED into clinical practice. It is important that a multifaceted approach is employed to improve cancer outcomes and reduce disparities in survival.
MCED tests, a relatively new advancement in genomic technology, have the potential to be an important component in cancer screening strategies.