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[°ÇÁø ÃÑ·Ð] - ðû

1. ±¹°¡¾Ï°ü¸®»ç¾÷ À̷аú ½ÇÁ¦ (¹ÚÀºÃ¶ ¿«À½)

Á¸°æÇÏ´Â ÀÌÁø¼ö ¿øÀå´ÔÀÇ Ãßõ»ç¿¡¼­ ÀϺθ¦ ¿Å±é´Ï´Ù. "¾ÏÀº ¿¹¹æµÉ ¼ö ÀÖÀ¸¸ç, ÇöÀçÀÇ ´É·ÂÀ¸·Îµµ Àüü ¾Ï »ç¸ÁÀÇ 2/3´Â ÁÙÀÏ ¼ö ÀÖ½À´Ï´Ù. ±Ý¿¬°ú ¹é½Å µîÀ¸·Î ¾ÏÀÇ 1/3Àº ¿¹¹æÇÒ ¼ö ÀÖÀ¸¸ç, Á¶±â °ËÁø°ú Á¶±â Ä¡·á¸¦ ÅëÇØ ¾Ï »ç¸ÁÀÇ 1/3Àº ¿¹¹æÇÒ ¼ö ÀÖ°í, ³ª¸ÓÁö 1/3µµ ¿ÏÈ­½Ãų ¼ö ÀÖ½À´Ï´Ù."

°£È¤ ÀÌ·± Áú¹®À» ¹Þ½À´Ï´Ù. "¼±»ý´Ô. ¸Å³â °ËÁøÀ» ¹Þ´Âµ¥ ¿Ö Á¦°¡ ¾Ï¿¡ °É·ÈÀ»±î¿ä? °ËÁøÇÏ¸é ¾ÏÀÌ ¿¹¹æµÇ´Â °Í ¾Æ´Õ´Ï±î?" ±×·¸½À´Ï´Ù. Àǻ簡 ¾Æ´Ñ ÀϹÝÀεéÀº °ËÁøÀÌ ¾ÏÀ» ¿¹¹æÇÏ´Â °ÍÀ¸·Î Âø°¢ÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. »ç½Ç ¸Å³â À§³»½Ã°æ °Ë»ç¸¦ ¹Þ´Â´Ù°í ¾ÏÀÌ ¿¹¹æµÇ´Â °ÍÀº ¾Æ´Õ´Ï´Ù. Á¶±â¿¡ Áø´ÜµÉ È®·üÀÌ ³ô¾ÆÁú »ÓÀÔ´Ï´Ù. Á¶±â °ËÁø°ú Á¶±â Ä¡·á¸¦ ÅëÇØ ¾Ï »ç¸ÁÀÇ 1/3ÀÌ ¿¹¹æµË´Ï´Ù. ¸¹´Ù¸é ¸¹°í Àû´Ù¸é Àû½À´Ï´Ù. Á¤È®ÇÑ È«º¸°¡ ÇÊ¿äÇÑ ºÐ¾ß¶ó°í »ý°¢ÇÕ´Ï´Ù.

Âü°í¹®Çå 25ÂÊ¿¡¼­ ¿Å±é´Ï´Ù. "ÁÁÀº ±âȹÀº ÁÁÀº Æò°¡¸¦ °¡´ÉÇÏ°Ô Çϸç, ÁÁÀº Æò°¡´Â ÁÁÀº ±âȹÀ» °¡´ÉÇÏ°Ô ÇÑ´Ù. ¸ñÇ¥¸¦ SMARTÇÏ°Ô ±â¼úÇÏ°í ÀÌ¿¡ ´ëÇØ ¸ð´ÏÅ͸µÇϴ ü°è¸¦ ±âȹÇϸé ÁÁÀº Æò°¡°¡ °¡´ÉÇØÁø´Ù." ¿©±â¼­ SMART´Â specific, measurable, appropriate, relevant, time-boundÀÇ ¾àÀÚÀÔ´Ï´Ù.

À§¾Ï¿¡ ´ëÇÑ »óºÎÀ§Àå°ü screening endoscopyÀÇ measurable outcomeÀº ¹«¾ùÀϱî¿ä? À§¾ÏÀ¸·Î ÀÎÇÑ »ç¸Á·ü °¨¼ÒÀϱî¿ä? À§¾Ï Áø´Ü ÈÄ Ä¡·á ¼ºÀûÀÇ Çâ»óÀϱî¿ä? ¾ÏÀº ¹«Á¶°Ç ¹ß°ßµÇ¾î¾ß ÇÏ´Â °ÍÀϱî¿ä? ¹ß°ßµÈ ¾ÏÀº ¹«Á¶°Ç Ä¡·áÇØ¾ß ÇÏ´Â °ÍÀϱî¿ä? Àå±â »ýÁ¸Àº °¡´ÉÇÏÁö¸¸ »îÀÇ ÁúÀÌ ¶³¾îÁú ¼ö ÀÖ´Â ¹®Á¦´Â ¾î¶»°Ô ÇÒ±î¿ä? °í·É¿¡¼­ ±¦ÇÑ ¾Ï Áø´ÜÀÌ °¡Á®¿À´Â È¥¼±Àº ¾î¶»°Ô ÇÒ±î¿ä? »ý°¢ÇÒ¼ö·Ï ¸Ó¸®°¡ ¾ÆÆÄ¿É´Ï´Ù.

Àú´Â ÀÌ·¸°Ô ÁÖÀåÇÕ´Ï´Ù. 'Screening endoscopyÀÇ ¸ñÀûÀº ÁÁÁö¸¸ °í·ÁÇØ¾ß ÇÒ detailÀÌ ¸¹´Ù. Áö±ÝÀÌ¶óµµ detailÇÏ°Ô °í¹ÎÇÏÀÚ.'

© 2011. 8. 24. ÀÌÁØÇà


2. À§¾Ï screeningÀ» À§ÇÑ °Ë»ç¹ý: 'UGIS or EGD' OR 'EGD or UGIS'

¾Ï°ËÁø ÇÁ·Î±×·¥¿¡¼­ °Ë»ç¹æ¹ýÀÇ ¼±ÅÃÀº ¹«Ã´ Áß¿äÇÕ´Ï´Ù. ±¹¸³¾Ï¼¾ÅÍÀÇ °ü·Ã ÀڷḦ º¸¸é 5´ë¾Ï °ËÁø ÇÁ·Î±×·¥ Áß À§¾ÏÀÇ °ËÁø¹æ¹ýÀº 'À§ÀåÁ¶¿µÃÔ¿µ¼ú ¶Ç´Â À§³»½Ã°æ°Ë»ç'·Î µÇ¾î ÀÖ½À´Ï´Ù. ¾Æ·¡ ±×¸²À» º¸½Ê½Ã¿À.

±×·±µ¥ ÀÏÀü¿¡ ¼Ò°³ÇÑ '±¹°¡¾Ï°ü¸®»ç¾÷ À̷аú ½ÇÁ¦' 85ÂÊÀ» º¸¸é 'À§³»½Ã°æ°Ë»ç ¶Ç´Â À§ÀåÁ¶¿µÃÔ¿µ'À¸·Î µÇ¾î ÀÖ½À´Ï´Ù. °°Àº°¡¿ä?

°°Áö¸¸ ´Ù¸£´Ù°í »ý°¢ÇÕ´Ï´Ù. ȨÆäÀÌÁö¿¡¼­´Â À§ÀåÁ¶¿µÃÔ¿µÀÌ ¾ÕÀÌ°í Ã¥¿¡¼­´Â À§³»½Ã°æÀÌ ¾ÕÀÔ´Ï´Ù. ¹°·Ð Á¢¼Ó»ç '¶Ç´Â'ÀÌ »ç¿ëµÇ¾úÀ¸¹Ç·Î ¼ø¼­´Â Áß¿äÇÏÁö ¾Ê´Ù°í ÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª ´À³¦ÀÌ ´Ù¸¨´Ï´Ù. ´À³¦ÀÌ...


±¹°¡¾ÏÁ¤º¸¼¾ÅÍ¿¡¼­ ±¹°¡¾Ï°ËÁø»ç¾÷À» ¼Ò°³ÇÑ ÀÚ·áµµ »ìÆ캸¾Ò½À´Ï´Ù. º»ÀÎÀÇ Èñ¸Á¿¡ µû¶ó À§ÀåÁ¶¿µÃÔ¿µ°ú À§³»½Ã°æ Áß ¼±ÅÃÇÒ ¼ö ÀÖ´Ù°í µÇ¾î ÀÖ½À´Ï´Ù. ±×·¯³ª '¼±Åà 1'ÀÌ À§ÀåÁ¶¿µÃÔ¿µÀÌ°í '¼±Åà 2'°¡ À§³»½Ã°æÀÔ´Ï´Ù. ¾Æ¹«¸® Èñ¸Á¿¡ µû¸¥ ¼±ÅûçÇ×À̶óÁö¸¸ ´À³¦ÀÌ ´Ù¸¨´Ï´Ù. ´À³¦ÀÌ...

© 2011. 8. 25. ÀÌÁØÇà


3. Opportunistic screening

'±¹°¡¾Ï°ü¸®»ç¾÷ À̷аú ½ÇÁ¦' 80ÂÊ¿¡¼­ ¿Å±é´Ï´Ù. "¾Ï°ËÁøÀº Å©°Ô Áý´Ü°ËÁø (organised screening, mass screening, population screening)°ú °³ÀΰËÁø (individualized screening, opportunistic screening)À¸·Î ±¸ºÐÇÒ ¼ö ÀÖ´Ù." ÀÌ Áß¿¡¼­ opportunistic screeningÀ̶ó´Â ¿ë¾î°¡ Á¦ °ü½ÉÀ» ²ü´Ï´Ù.

Colorectal cancer screening: opportunistic or organized? (Rabeneck . Can J Gastroenterol 2006;20:249-250)¸¦ ¼Ò°³ÇÕ´Ï´Ù. ±× ÀϺθ¦ ¿Å±é´Ï´Ù.

Áú¹® (Paul Adams, Editor-in-chief): Can you explain the current practice of opportunistic screening and how it compares with the program that you are proposing?

´äº¯ (Linda Rabeneck): Opportunistic screening is what we are all doing now in Canada. This is completely ad hoc. It depends on either a general practitioner or the patient raising the issue, and because this often is not mentioned during an office visit, screening does not happen. For example, we know that less than 20% of screen-eligible individuals in Ontario are screened, using any method. Organized screening would include, at a minimum, the following:

- invitations to screen targeted at the screen-eligible population;
- information technology infrastructure to support the screening program;
- timely access to screening and follow-up tests (colonoscopy);
- quality assurance (credentialing of endoscopist, measurement of colonoscopy adverse events, measurement of proportion of incomplete colonoscopies, etc); and
- tracking of clinical outcomes (CRC incidence, CRC stage, CRC mortality).

2008³â ¿ì¸®³ª¶ó À§¾Ï °ËÁø±Ç°í¾È ÀÌÇà ¼ö°Ë·üÀº 53.5%¿´½À´Ï´Ù. ÀÌ Áß¿¡¼­ ¾î´À Á¤µµ°¡ opportunistic screeningÀÎÁö ¸íÈ®È÷ ¹àÈù ÀڷḦ º» ÀûÀÌ ¾ø½À´Ï´Ù. ´Ù¸¸ '±¹°¡¾Ï°ü¸®»ç¾÷ À̷аú ½ÇÁ¦'¿¡¼­ ¾à°£ÀÇ ÈùÆ®¸¦ ¾òÀ» ¼ö ÀÖÀ» »ÓÀÔ´Ï´Ù. 87-88ÂÊ¿¡¼­ ¿Å±é´Ï´Ù.

"2007³â ±¹°¡¾ÏÁ¶±â°ËÁø»ç¾÷ÀÇ °æ¿ì Àüü ´ë»óÀÚÀÇ ¾à 24%, °ø´Ü ƯÁ¤¾Ï°Ë»çÀÇ °æ¿ì ¾à 31%°¡ ¾Ï°ËÁø»ç¾÷¿¡ Âü¿©ÇÏ¿´´Ù. ÇÑÆí ¿ì¸®³ª¶ó ±¹¹ÎÀÇ 50.7%´Â 5´ë¾Ï °ËÁø±Ç°í¾Ï¿¡ µû¶ó °ËÁøÀ» ¹Þ°í ÀÖ´Â °ÍÀ¸·Î Á¶»çµÇ¾ú´Ù. ÀÌ´Â °ø°ø°ËÁø°ú °³ÀΰËÁøÀ» ¸ðµÎ Æ÷ÇÔÇÑ °ÍÀ¸·Î 2004³â 38.8%¿¡ ºñÇØ 11.9% Æ÷ÀÎÆ®°¡ Áõ°¡ÇÑ ¼öÄ¡ÀÌ´Ù."

© 2011. 8. 26. ÀÌÁØÇà


4. Psychologic response

°Ç°­°ËÁø¿¡ ´ëÇÑ º¸´Ù »ó¼¼ÇÑ ³íÀÇ¿¡ ¾Õ¼­ ²À ¼Ò°³ÇÏ°í ½ÍÀº ±ÛÀÌ ÀÖ½À´Ï´Ù. Á¦¸ñÀº °Ç°­¿°·ÁÁõ »çȸ¿Í °Ç°­°ËÁø. °¡Å縯ÀÇ´ë Àι®»çȸÀÇÇаú ÃÖº¸¹® ±³¼ö°¡ 2010³â 6¿ù ±â°íÇÑ ³»¿ëÀÔ´Ï´Ù. Àü¹®À» Àо½Ã±æ ±ÇÇÕ´Ï´Ù. ¹Ù»Ú½Å ºÐµéÀ» À§ÇÏ¿© ±× ÀϺθ¦ ¿Å±é´Ï´Ù.

"°Ç°­°ËÁøÀ̶ó°í Çϸé, '°Ç°­ÇØ º¸ÀÌ´Â »ç¶÷ ȤÀº Áõ»óÀÌ ¾ø´Â »ç¶÷'¿¡°Ô ÀÏÁ¤ ¼öÁØÀÇ °Ë»çµéÀ» ½ÃÇàÇÏ´Â °ÍÀÌ°í, ÀÌ´Â °øÁߺ¸°Ç°ü¸®¿¡ À¯¿ëÇÑ µµ±¸ÀÌ´Ù. ±×·¯³ª ±¹¹Î°Ç°­À» À¯ÁöÇϴµ¥ ÇÊ¿äÇÑ µµ±¸¶ó°í Çؼ­ ¹Ýµå½Ã À±¸®ÀûÀÎ °ÍÀÎÁö¿¡ ´ëÇؼ­´Â Áú¹®ÇØ º¼ ÇÊ¿ä°¡ ÀÖ´Ù. Áï °Ë»ç°¡ ÇÕ´çÇÏ°í À±¸®ÀûÀ̱â À§Çؼ­´Â ±× °á°ú·Î ÀÎÇØ À̵æÀ» º¼ ¼ö ÀÖ¾î¾ß ÇÑ´Ù´Â ÀüÁ¦°¡ Àִ°¡¶ó´Â Áú¹®ÀÌ´Ù..... °Ç°­ ±× ÀÚü°¡ »îÀÇ ¸ñÀûÀÌ µÇ¹ö·È°Å³ª ±Ã±ØÀûÀ¸·Î ÁöÇâÇØ¾ß ÇÒ ¹æÇâ°ú °°ÀÌ µÇ¹ö¸° °ÍÀÌ´Ù. ÀÌ ´ö¸ñÀ» Áö´Ï±â À§Çؼ­´Â »ýÈ°ÀÇ ¼¼¼¼ÇÑ ºÎºÐ ¸ðµç °÷¿¡ ´«À» ºÎ¸¨¶ß°í ÀÖ¾î¾ß ÇÏ°í, Á¤±âÀûÀ¸·Î ¿Â¸óÀ» »ô»ôÀÌ µÚÁö´Â ÀÇ·á¼ÒºñÈ°µ¿À» ÇÏ´Â °ÍÀÌ °Ç°­ÇÑ »ýÈ°¹æ½ÄÀ¸·Î Àνĵǰí ÀÖ´Â °ÍÀÌ´Ù. °¡È÷ ¿Â »çȸ°¡ °Ç°­¿°·ÁÁõ¿¡ ºüÁ®ÀÖ´Ù°í Çصµ ¹«¹æÇÒ Á¤µµÀÌ´Ù."

±×·¸½À´Ï´Ù. °Ç°­Àº ÇູÇÑ ÀλýÀÇ Áß¿äÇÑ ¿ä¼Ò Áß ÇϳªÀÏ »ÓÀÔ´Ï´Ù. »îÀÇ À¯ÀÏÇÑ ¸ñÀûÀº ¾Æ´Ñ °ÍÀÔ´Ï´Ù. °Ç°­ÇÏÁö ¾Ê¾Æµµ ÇູÇÑ »ç¶÷Àº ¾ó¸¶µçÁö ÀÖ½À´Ï´Ù. °Ç°­¿¡ ´ëÇÑ °ü½Éµµ Àû´çÇØ¾ß ÇÕ´Ï´Ù.

© 2011. 8. 27. ÀÌÁØÇà


5. Hoerr's law -- it is difficult to make the asymptomatic patient feel better]

Screening endoscopy¿¡ ´ëÇÏ¿© »ý°¢Çϸé Hoerr's law¸¦ ¶°¿Ã¸®Áö ¾ÊÀ» ¼ö ¾ø½À´Ï´Ù. 2011³â 6¿ù 5ÀÏÀÚ endoTODAY¿¡¼­ ¼Ò°³ÇÑ ¹Ù ÀÖÁö¸¸ ´Ù½Ã Çѹø Àü¹®À» ¿Å±é´Ï´Ù (Am J Surg 1962;103:411). °úÀ×Ä¡·á¿Í °úÀ×Áø´ÜÀÌ ³­¹«ÇÏ´Â ¾îÁö·¯¿î Çö½Ç¿¡ °æÁ¾À» ¿ï¸®´Â ¾Æ¸§´Ù¿î ±ÛÀÔ´Ï´Ù.

The surgeon is a man of action. By temperament and by training he prefers to serve the sick by operating on them, and he inwardly commiserates with a patient so unfortunate as to have a disease not suited to surgical treatment. Young surgeons, busy mastering the technicalities of the art, are particularly alert to seize every legitimate opportunity to practice technical maneuvers, the more complicated the better.

In an effort to remind my young colleagues, as well as myself, that our goal as physicians is the betterment of the lot of the patient, I have formulated a ten word statement that I have modestly named Hoerr¡¯s Law.

It is difficult to make the asymptomatic patient feel better.

This is not to say that the patient with an asymptomatic cancer will not be helped by having it skillfully removed, even though he will feel no better than he did before the operation. On the other hand, there are patients who have benign surgically correctible conditions of which they are unaware. But surgeons, old and young, should ponder well the possible benefit to the asymptomatic patient before they advise on operation for such abnormalities as a slight bulge in the inguinal area, which may or may not develop into a significant hernia; a fibroid uterus, or a silent, solitary gallstone in a aged person. Operation for such conditions, on occasion, may be best, but its advisability should never be taken as a matter of course.

We should always let our judgments and recommendations be guided by the fact that we operate on patients, not on diseases.

Stanley O. Hoerr, M.D., F.A.C.S.
Department of General Surgery
The Cleveland Clinic Foundation
and The Frank E. Bunts Educational Institute
Cleveland, Ohio

© 2011. 8. 28. ÀÌÁØÇà


6. [2014-11-18] µÎ°¡Áö Áß¿äÇÑ ºñƲ¸² (Two important bias)

°ÇÁø¿¡ Á¶±ÝÀÌ¶óµµ °ü½ÉÀÌ ÀÖÀ¸¸é ¾Æ·¡ ³í¹®À» ²À Àо½Ã±â¸¦ ±ÇÇÑ ¹Ù ÀÖ½À´Ï´Ù.

Minsoo Jung. National Cancer Screening Programs and Evidence-Based Healthcare Policy in South Korea. Health Policy (2014)

°Ç°­°ËÁø¿¡¼­ ¹ß°ßÇÑ ¾ÏÀº Àß Ä¡·áµÇ´Â °Í °°°í, ¿À·¡ »ç´Â °Í °°´Ù´Â ´À³¦À» °¡Áø ºÐµéÀÌ ¸¹À» °ÍÀÔ´Ï´Ù. ±×·±µ¥ lead time bias¿Í length time bias¶ó´Â µÎ°³ÀÇ Áß¿äÇÑ ºñƲ¸²ÀÌ ¿©·¯ºÐÀÇ ÆÇ´ÜÀ» ¾î·Æ°Ô ÇÒ °ÍÀÔ´Ï´Ù. À§ ³í¹®¿¡ µÎ °¡Áö bias¿¡ ´ëÇÏ¿© ÀÚ¼¼ÇÑ ¼³¸íÀÌ ÀÖ½À´Ï´Ù. ÇÏÁö¸¸ Á¦°¡ ´Ù½Ã ¼³¸íÇغ¸°Ú½À´Ï´Ù. Áß¿äÇϴϱî.

¸ÕÀú lead time biasÀÔ´Ï´Ù. ¿¹¸¦ µé¾î °ÇÁø¿¡¼­ ¹ß°ßµÈ ¾ÏȯÀÚÀÇ »ýÁ¸±â°£ÀÌ 6³âÀÌ°í, Áõ»óÀÌ ¹ß»ýÇÑ ÈÄ ¿Ü·¡¿¡¼­ ¹ß°ßµÈ ¾ÏȯÀÚÀÇ »ýÁ¸±â°£ÀÌ 3³âÀ̶ó°í ÇսôÙ. 3³âÀ̶ó´Â Â÷ÀÌ°¡ °ÇÁøÀÇ È¿°úÀÎÁö ¾Æ´Ï¸é ´ÜÁö ¸î ³â ¸ÕÀú ¹ß°ßµÈ °á°úÀÎÁö ±¸ºÐÇϱ⠾î·Æ½À´Ï´Ù. ¸¸¾à 3³âÀ̶ó´Â »ýÁ¸±â°£ÀÇ Â÷ÀÌ°¡ ´ÜÁö ¸ÕÀú ¹ß°ßµÈ °á°úÀÏ »ÓÀ̶ó¸é ¸ÕÀú ¹ß°ßÇÒ ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. º´À» ¸ð¸£°í ÇູÇÏ°Ô »ì´Ù°¡ ¾î´À ³¯ Áõ»óÀÌ ¹ß»ýÇÑ ÈÄ Ä¡·áÇصµ °á°ú°¡ ¸¶Âù°¡Áö¶ó¸é ¸ÕÀú ¹ß°ßÇÒ ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. ÀÌ·¯ÇÑ °¡´É¼ºÀÌ lead time biasÀÔ´Ï´Ù.

Á¦°¡ ´õ Áß¿äÇÏ°Ô »ý°¢ÇÏ´Â °ÍÀº length time biasÀÔ´Ï´Ù. ¾î¶² ¾ÏÀº õõÈ÷ ÀÚ¶ó°í ¾î¶² ¾ÏÀº »¡¸® ÀÚ¶ø´Ï´Ù. Á¤±âÀûÀÎ °ËÁøÀ» ÅëÇÏ¿© ¹ß°ßµÇ´Â ¾ÏÀº õõÈ÷ ÀÚ¶ó´Â ¾ÏÀÏ È®·üÀÌ ³ô½À´Ï´Ù. »¡¸® ÀÚ¶ó´Â ¾ÏÀº ¾Æ¹« ¶§³ª Áõ»óÀ» ÀÏÀ¸Å³ °ÍÀ̹ǷΠ°ÇÁø¿¡¼­ Áø´ÜµÉ È®·üÀÌ ³·½À´Ï´Ù. °ÇÁø¿¡¼­ ¹ß°ßµÈ ¾ÏÀÇ Ä¡·á¼ºÀûÀÌ ÁÁÀº °ÍÀº ¿ø·¡ºÎÅÍ ÃµÃµÈ÷ ÀÚ¶ó´Â ¾ÏÀ̱⠶§¹®ÀÏ ¼ö ÀÖ½À´Ï´Ù. ¾Ö½Ã´çÃÊ ÁÁÀº ¾ÏÀÌ °ÇÁø¿¡¼­ Áø´ÜµÇ±â ½±½À´Ï´Ù. ÀÌ·¯ÇÑ °¡´É¼ºÀÌ length time biasÀÔ´Ï´Ù.

Length time bias¸¦ Á¦ ½ºÅ¸ÀÏ·Î ´Ù½Ã ±×·Áº¸¸é ¾Æ·¡ ±×¸²°ú °°½À´Ï´Ù. ¿ì¸®°¡ ¾òÀº ¼ºÀûÀÌ lead time bias³ª length time biasÀÇ °á°ú´Â ¾Æ´Ï¶ó´Â °ÍÀ» °úÇÐÀûÀ¸·Î ÀÔÁõÇÒ ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù. ÁÁÀº °Í °°´Ù´Â ´À³¦°ú Á¤¸»·Î ÁÁÀº °ÍÀº ´Ù¸¦ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù.

New Engl J Med¿¡¼­ bias¿¡ ´ëÇÏ¿© ¼³¸íÇÑ ºÎºÐÀÌ À־ ±×¸²À» ¿Å±é´Ï´Ù.


NEJM (2000) Figure 1. Lead-Time Bias. In the example shown, the diagnosis of disease is made earlier in the screened group, resulting in an apparent increase in survival time (lead-time bias), although the time of death is the same in both groups.


NEJM (2000) Figure 2. Length-Time Bias. The probability of detecting disease is related to the growth rate of the tumor. Aggressive, rapidly growing tumors have a short potential screening period (the interval between possible detection and the occurrence of symptoms). Thus, unless the screening test is repeated frequently, patients with aggressive tumors are more likely to present with symptoms. More slowly growing tumors have a longer potential screening period and are more likely to be detected when they are asymptomatic. As a result, a higher proportion of indolent tumors is found in the screened group, causing an apparent improvement in survival.


NEJM (2000) Figure 3. Overdiagnosis Bias. Overdiagnosis bias is an extreme form of length-time bias. The detection of very indolent tumors in the screened group produces apparent increases in the number of cases of lung cancer (three in the screened group in the figure and one in the control group) and in survival (two of three patients in the screened group were treated and died of natural causes, without evidence of disease [66 percent survival], and the one patient in the control group did not survive [0 percent survival]), with no effect on mortality (one death from lung cancer in each group). Two patients in the control group died with undiagnosed lung cancer that did not affect their natural life span.


2016³â 1¿ùÈ£ Endoscopy Áö¿¡ Do's and don'ts in evaluation of endoscopic screening for gastrointestinal cancers¶ó´Â Á¦¸ñÀÇ Èï¹Ì·Î¿î ¸®ºä°¡ ½Ç·È½À´Ï´Ù(Bretthauer M. Endoscopy 2016). ¾Ï°ËÁø¿¡´Â lead time bias¿Í length time bias°¡ ¹®Á¦¶ó´Â °ÍÀº ´Ùµé µéÀ¸¼ÌÀ» °ÍÀÔ´Ï´Ù. °ËÁø¿¡¼­´Â õõÈ÷ ÀÚ¶ó´Â ¾ÏÀÌ Áø´ÜµÇ°í »¡¸® ÀÚ¶ó´Â ¾ÏÀº °ËÁøÀ¸·Î Áø´ÜµÇÁö ¾ÊÀ» ¼ö ÀÖ´Ù´Â length time bias¸¦ ¼³¸íÇϴ°ÍÀº ½¬¿î ÀÏÀÌ ¾Æ´Ï¾ú½À´Ï´Ù. À̹ø ¸®ºäÀÇ ±×¸²Àº length time biasÀ» Âü ¾Ë±â ½±°Ô º¸¿©ÁÖ°í ÀÖ½À´Ï´Ù. (°úÀåÇÏ¿© ¸»Çϸé) ²À ÇÊ¿äÇÑ º´Àº ¹ß°ßµÇÁö ¾Ê°í º°·Î ¹ß°ßÇÏÁö ¾Ê¾Æµµ ÁÁÀ» º´¸¸ ¿Õ⠹߰ߵǴ °ÍÀÌ °ËÁøÀÏ ¼ö ÀÖ½À´Ï´Ù. °ËÁø ÇÁ·Î±×·¥À» ±âȹÇÏ°í °ËÁøÀÇ È¿°ú¸¦ È«º¸ÇÒ ¶§ ÀÌ Á¡À» °£°úÇÏÁö ¸»¾Æ¾ß ÇÕ´Ï´Ù.

Survival and lead-time bias in cancer screening. No-screening (upper time line) and screening (lower time line) in identical tumor growth scenarios are compared. In the example shown, there is no net effect of screening (time points of death are similar for screening and no-screening scenarios). The time of start of tumor growth, clinical detection, screening detection, and death are marked on the two timelines. The solid green line illustrates the time without a cancer diagnosis, the dotted green line illustrates the lead time (the individual is living with a cancer diagnosis after screening), and the dotted black line illustrates the time from the clinical diagnosis until death.

Length-time bias in cancer screening. The black arrows represent different tumor growth rates (fast, slow, very slow, nonprogressive). The red arrows represent screening events (time points at which screening is performed). Fast-growing tumors are more likely than slow-growing tumors to become symptomatic and to be diagnosed clinically before or between screening events. Thus, undersampling of fast-growing tumors (worse prognosis) compared with slow-growing tumors (better prognosis) is called the length-time bias.|


7. [2014-11-19] ¼¼ »óȲ (Three scenarios)

¾Ï°ËÁøÀ» ÅëÇÏ¿© ¾òÀ» ¼ö ÀÖ´Â ÃÖ¼±ÀÇ »óȲÀº ¹«¾ùÀϱî¿ä? ¸ðµç ¾ÏÀ» ÀÏÂï ¹ß°ßÇÏ°í Àß Ä¡·áÇÏ¿© ´ÙÇÔ²² °Ç°­ÇÏ°Ô Àå¼öÇÏ´Â °ÍÀÔ´Ï´Ù. ±×·±µ¥ »óȲÀº ±×¸® ´Ü¼øÇÏÁö ¾Ê½À´Ï´Ù. ¾Ï°ËÁøÀ» ÅëÇÏ¿© ¾òÀ» ¼ö ÀÖ´Â µæµµ ÀÖÁö¸¸ ÇÇÇÒ ¼ö ¾ø´Â ½Çµµ Àֱ⠶§¹®ÀÔ´Ï´Ù.

¾Ï°ËÁøÀÌ °¡Á®¿Ã ¼ö ÀÖ´Â »óȲÀ» »ý°¢ÇØ º¾½Ã´Ù. ¾ÏÀ» Å©°Ô Á¶±â¾Ï(early cancer)¿Í ÁøÇà¾Ï(advanced cancer)À¸·Î ³ª´« ÈÄ Á¶±â¾ÏÀº Àß Ä¡·áÇÒ ¼ö ÀÖ°í ÁøÇà¾ÏÀº Ä¡·áÇϱ⠾î·Æ´Ù°í °¡Á¤ÇÏ¿´½À´Ï´Ù.


1) »óȲ 1 - Á¶±â¾ÏÀº ´Ã°í ÁøÇà¾ÏÀº ÁÙ°í, ÇÕÀº ±×´ë·Î

°¡Àå ÀÌ»óÀûÀÎ »óȲÀÔ´Ï´Ù. ¾Ï°ËÁøÀ» ÅëÇÏ¿© Á¶±â¾ÏÀº ´Ã°í, ÁøÇà¾ÏÀº ÁÙ°í, Àüü ¾ÏȯÀÚÀÇ ¼ö´Â ±×´ë·ÎÀÎ °æ¿ìÀÔ´Ï´Ù. ¾îÂ¥ÇÇ ¾ÏÀ¸·Î Áø´ÜµÉ ȯÀÚ¸¦ ÀÏÂï ¹ß°ßÇÏ°í ÀÏÂï Ä¡·áÇϱ⠶§¹®¿¡ »ýÁ¸±â°£ ¿¬ÀåÀ» ±â´ëÇÒ ¼ö ÀÖ½À´Ï´Ù. ¹°·Ð lead time bias¸¦ °í·ÁÇØ¾ß ÇÕ´Ï´Ù. ÀÏÂï Ä¡·áÇÑ´Ù°í ²À ¿À·¡»ê´Ù´Â ¹ýÀº ¾øÀ¸´Ï±î¿ä...... ¿©ÇÏÆ° ÃÖ¼±ÀÇ »óȲÀÔ´Ï´Ù.

¹®Á¦´Â ÀÌ¿Í °°Àº ÃÖ¼±ÀÇ »óȲÀº Àý´ë ¹ß»ýÇÏÁö ¾Ê´Â´Ù´Â °ÍÀÔ´Ï´Ù. ¾Ï°ËÁøÀ» ÇÏ¸é ¾ÏÀ¸·Î Áø´ÜµÇ´Â ȯÀÚ°¡ ´Ã¾î³³´Ï´Ù. Åë»óÀÇ »óȲ¿¡¼­´Â ¹ß°ßµÇÁö ¾ÊÀ» ÀÛÀº ¾ÏµéÀÌ ¹«´õ±â·Î ¹ß°ßµÇ±â ¶§¹®ÀÔ´Ï´Ù. ¾Ï°ËÁøÀ» ÅëÇÏ¿© ¾ÏÀ» ¿¹¹æÇÏÀÚ´Â ¸»Àº °ÅÁþ¸»ÀÔ´Ï´Ù. ´ëÀå³»½Ã°æó·³ Àü¾Ï¼ºº´¼Ò¸¦ ¹ß°ßÇÏ¿© ¾ÈÀüÇÏ°Ô Ä¡·áÇÒ ¼ö ÀÖ´Â ±ØÈ÷ µå¹® »óȲ¿¡¼­¸¸ ÅëÇÏ´Â ¸»À̱⠶§¹®ÀÔ´Ï´Ù. ¾Ï°ËÁøÀ» ÇÏ¸é ¾ÏÀÌ ¸¹¾ÆÁø´Ù°í º¸´Â ÆíÀÌ ³´½À´Ï´Ù.


2) »óȲ 2 - Á¶±â¾ÏÀº ´Ã°í ÁøÇà¾ÏÀº ÁÙÁö¸¸ ±× ÇÕµµ ´Ã¾î³²

ÀÇ»çµéÀÌ ±â´ëÇÏ´Â »óȲÀÔ´Ï´Ù. ¾Ï°ËÁøÀ» ÅëÇÏ¿© Á¶±â¾ÏÀº ´Ã°í, ÁøÇà¾ÏÀº ÁÙÁö¸¸, Àüü ¾ÏȯÀÚÀÇ ¼ö°¡ Áõ°¡ÇÏ´Â °æ¿ìÀÔ´Ï´Ù. Ä¡·á°¡ ¾î·Á¿î ÁøÇà¾ÏÀÌ °¨¼ÒÇÏ¿© ¾Ï»ç¸ÁÀÌ °¨¼ÒÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª Á¶±â¾Ï ¶§¹®¿¡ ÀÌ·± Àú·± °í»ýÀ» Çϴ ȯÀÚ´Â ¸¹¾ÆÁý´Ï´Ù. À§¾Ï °ËÁøÀÌ ÀÌ¿Í °°Àº µÎ¹ø° »óȲ¿¡ ÇØ´çÇÑ´Ù°í ÃßÁ¤µË´Ï´Ù. ÀÚ·á´Â ¾øÀ¸¹Ç·Î ±×³É ÃßÁ¤ÀÔ´Ï´Ù. Èñ¸ÁÀÏ ¼öµµ ÀÖ½À´Ï´Ù. ¾Æ´Ò ¼öµµ ÀÖ½À´Ï´Ù. ¿©ÇÏÆ° ¿¬±¸°¡ ÇÊ¿äÇÕ´Ï´Ù.

°ü°ÇÀº Àüü¾ÏÀÇ Áõ°¡ ÆøÀÔ´Ï´Ù. ÁøÇà¾ÏÀÌ Á¶±Ý ÁÙ¾úÁö¸¸ Á¶±â¾ÏÀÌ ¿Õ⠴þ´Ù¸é ¾Ï°ËÁøÀÇ µæ°ú ½ÇÀ» Àß »ý°¢Çغ¸¾Æ¾ß ÇÕ´Ï´Ù. ÀÏ´Ü Á¤È®ÇÑ ÀÚ·áºÎÅÍ ¾Ë¾Æ¾ß ÇÒ °ÍÀÔ´Ï´Ù. ±×·±µ¥ ÀÚ·á°¡ ¾ø½À´Ï´Ù. ÀÚ·á°¡... ¾ø´Â °ÍÀÎÁö ¾È º¸¿©ÁÖ´Â °ÍÀÎÁö ¾Ë ¼ö ¾øÁö¸¸ ¿©ÇÏÆ° Á¤È®ÇÑ »óȲÀ» ¾Ë±â ¾î·Æ½À´Ï´Ù.


3) »óȲ 3 - Á¶±â¾ÏÀº ´ÃÁö¸¸ ÁøÇà¾ÏÀº ±×´ë·Î

°¡Àå ³ª»Û °æ¿ìÀÔ´Ï´Ù. »ý¸íÀ» À§ÇùÇÏ´Â ÁøÇà¾ÏÀº ¹ß°ßÇÏÁö ¸øÇÏ°í Á¶±â¾Ï¸¸ ¿Õ⠹߰ßÇÏ´Â °æ¿ìÀÔ´Ï´Ù. ¾Ï»ç¸Á·üÀº °¨¼ÒÇÏÁö ¾Ê°í ¾ÏÄ¡·á¿¡ µû¸¥ °³ÀÎÀû, »çȸÀû °íÅ븸 Áõ°¡ÇÕ´Ï´Ù. ¹°·Ð ¾öû¸¹Àº ºñ¿ëÀÌ ¼Ò¿äµË´Ï´Ù. ÇÊ¿ä¾ø´Â Ä¡·á¸¦ ÇÏ´À¶ó ¸·»ó ÇÊ¿äÇÑ Ä¡·á¸¦ ¸øÇÏ´Â »óȲ¿¡ óÇÒ À§Çèµµ ÀÖ½À´Ï´Ù. °©»ó¼±¾Ï °ËÁøÀÌ ÀÌ·¯ÇÑ »óȲÀ̶ó°í Àǽɹްí ÀÖ½À´Ï´Ù.

¾î¶² ¾Ï°ËÁøÀÌ »óȲ 3¿¡ ÇØ´çÇÑ´Ù¸é ´çÀå ÁߴܵǾî¾ß ÇÕ´Ï´Ù. »ýÁ¸±â°£À» Áõ°¡½ÃÅ°Áö ¸øÇϸ鼭 ¾öû ¸¹Àº »ç¶÷À» °í»ý½ÃÅ°±â ¶§¹®ÀÔ´Ï´Ù. ºÒÇÊ¿äÇÑ Ä¡·á¸¦ ¹Þ´Ù°¡ »ç¸ÁÇϴ ȯÀÚ°¡ ³ª¿Ã ¼ö ÀÖ½À´Ï´Ù. ÇÕº´ÁõÀ¸·Î °í»ýÇϴ ȯÀÚ°¡ ³ª¿Ã ¼ö ÀÖ½À´Ï´Ù. ÀÏÀü¿¡ ¼Ò°³ÇÑ Çã´ë¼® ¼±»ý´ÔÀÇ °æÇâ½Å¹® ±â°í¸¦ ÀϺΠ¿Å±é´Ï´Ù.

"¾Ï °ËÁøÀÇ ¸ñÀûÀº ¾ÏÀ» Á¶±â¿¡ ¹ß°ßÇÏ°í Ä¡·áÇÏ¿©, ¿ÏÄ¡À²À» ³ôÀÌ°í »ç¸Á·üÀ» °¨¼Ò½ÃÅ°´Â °ÍÀÌ´Ù. ½ÇÁ¦·Î ÀڱðæºÎ¾Ï, ´ëÀå¾Ï, À¯¹æ¾Ï, À§¾Ï µî¿¡¼­´Â Á¶±â °ËÁø ÈÄ »ç¸Á·üÀÌ °¨¼ÒÇϱ⠶§¹®¿¡ ¼±Áø±¹¿¡¼­µµ Á¶±â°ËÁøÀ» ±ÇÀåÇÏ°í ÀÖ´Ù. ±×·¯³ª °©»ó»ù¾ÏÀÇ °æ¿ì, Àû±ØÀûÀ¸·Î Á¶±â°ËÁø°ú Ä¡·á¸¦ ÇØ¿Â Çѱ¹¿¡¼­ ¹Ì¼¼ °©»ó»ù¾ÏÀÇ Áø´ÜÀÌ ±Þ°ÝÈ÷ Áõ°¡Çϸ鼭 ¼ö¼ú¹ÞÀº ȯÀÚÀÇ ¿ÏÄ¡À²Àº °³¼±µÈ °Íó·³ º¸ÀÌÁö¸¸, °©»ó»ù¾ÏÀ¸·Î »ç¸ÁÇÑ ±¹¹ÎÀÇ ¼ö´Â 2000³â 266¸í¿¡¼­ 2010³â 356¸íÀ¸·Î È£ÀüµÇÁö ¾Ê°í ÀÖ´Ù(Åë°èû). ¼¼°èº¸°Ç±â±¸ ÀÚ·á»ó 2012³â Çѱ¹ÀÎ °©»ó»ù¾ÏÀÇ ¿¬·ÉÇ¥ÁØÈ­ »ç¸Á·üÀº 10¸¸¸í´ç 0.5¸íÀ¸·Î ¹Ì±¹(0.3¸í), ÀϺ»(0.4¸í)°ú À¯»çÇÏ´Ù."

°©»ó¼±¾Ï °ËÁøÀ» ÇßÀ½¿¡µµ ºÒ±¸ÇÏ°í »ç¸Á·üÀÌ ÁÙÁö ¾Ê´Â´Ù´Â Á¡À» ÁöÀûÇÏ°í °è½Ê´Ï´Ù. Çϳª¸¶³ª°¡ ¾Æ´Ï¶ó ¾ÈÇϴϸ¸ ¸øÇÏ´Ù°í ¸»¾¸ÇÏ°í °è½Ã´Â °ÍÀÔ´Ï´Ù. ÃÖ±Ù ¾ÈÇü½Ä ±³¼ö´Ô²²¼­ New England Journal of Medicine¿¡ ±â°íÇÑ ³»¿ëµµ Å©°Ô ´Ù¸£Áö ¾Ê½À´Ï´Ù.


8. [2014-12-7] ¾Ï °úÀ× Áø´Ü


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15. Myth


16. Specialist vs generalist

[2014-12-5] À§¾Ï Àü¹®ÀÇ°¡ ¿Ö ´Ù¸¥ ¾Ï¿¡ °ü½ÉÀ» °®´ÂÁö Áú¹®À» ¹Þ¾Ò½À´Ï´Ù. ³²ÀÇ ¿µ¿ªÀ» ¿³º¸´Â °Í¿¡ ´ëÇÑ Ç×ÀÇÀÎÁö´Â ¸ð¸£°ÚÁö¸¸ (ºÐÀ§±â´Â ÁÁ¾Ò½À´Ï´Ù), ±×·± Áú¹®À» ¹Þ°í º¸´Ï Á¦°¡ ¹«½¼ ºñ¹Ð°æÂûÀ̳ª µÈ °Í °°Àº ´À³¦À̾ú½À´Ï´Ù. »ç½Ç 'ÂøÇÑ °£¼·'À» ÇÏ°í ½Í¾ú´Âµ¥...

Àú´Â specialist¸¦ ÁöÇâÇÏÁö ¾Ê½À´Ï´Ù. Specialist °â generalist¸¦ ÁöÇâÇÏ°í ÀÖ½À´Ï´Ù. Çϳª¸¸ °í¸£¶ó¸é generalistÀÔ´Ï´Ù. ÁÖº¯¿¡ specialist´Â ³ÑÄ¡´Âµ¥ generalist´Â °ÅÀÇ ¾ø±â ¶§¹®ÀÔ´Ï´Ù. ±×·¡¼­ Àú´Â À§¾Ï¿¡¸¸ °ü½ÉÀÌ µÎÁö ¾Ê°í °ËÁø ´ë»óÀÌ µÇ´Â ¿©·¯ ¾ÏÀ» ±â¿ô°Å¸®°í ÀÖ½À´Ï´Ù.


18. [2018³â 6¿ù 23ÀÏ Çѱ¹-¸ù°í À§¾Ï ½ÉÆ÷Áö¾ö] Korean gastric cancer screening program, algorithms and experience (ÀÌÁØÇà)

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¸î °³ÀÇ Áú¹®ÀÌ ÀÖ¾ú½À´Ï´Ù.

[2018-6-23 Áú¹®] ÀϺ»¿¡¼­´Â screening Âü¿©À²ÀÌ 10%Àε¥ ¹ÝÇÏ¿© Çѱ¹¿¡¼­´Â screening Âü¿©À²ÀÌ 45% ÀÌ»óÀÎ ÀÌÀ¯´Â ¹«¾ùÀԴϱî?

[2018-6-23 ÀÌÁØÇà ´äº¯] Á¤ºÎ program Âü¿©À²ÀÌ 45%ÀÌÁö¸¸, ȸ»ç ȤÀº °³ÀÎÀÌ ÁöºÒÇÏ´Â opportunistic screeningµµ 30% Á¤µµÀ̹ǷΠ½ÇÁ¦·Î À§¾Ï °ËÁø Âü¿©À²Àº 75%ÀÔ´Ï´Ù. (1) ¿ª»ç°¡ ¿À·¡µÇ¾ú½À´Ï´Ù. (2) Á¤ºÎ¿¡¼­ °­ÇÏ°Ô ÃßÁøÇÏ°í ÀÖ½À´Ï´Ù. (3) ±¹¹Îµé¿¡°Ô È«º¸°¡ Àß µÇ¾î ÀÖ½À´Ï´Ù.

[2018-6-23 Áú¹®] ºñ¿ë ±¸Á¶´Â ¾î¶»°Ô µÇ¾îÀÖ½À´Ï±î?

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[2018-6-23 Áú¹®] °ËÁø ³»½Ã°æÀÇ sensitivity´Â ¾î´À Á¤µµÀԴϱî?

[2018-6-23 ÀÌÁØÇà ´äº¯] °ËÁø ³»½Ã°æÀÇ sensitivity¸¦ ÃøÁ¤ÇÏ´Â °ÍÀº ¸Å¿ì ¾î·Æ½À´Ï´Ù. 75%-85% Á¤µµ¶ó´Â ÀϺ»°ú Çѱ¹ÀÇ º¸°í°¡ ÀÖ½À´Ï´Ù¸¸, °ËÁø ³»½Ã°æÀ» ´ã´çÇÏ´Â Àü¹®°¡¿¡ ÀÇÇÑ ³»½Ã°æ °Ë»çÀÇ ¾ÏÁø´Ü sensitivity´Â À̺¸´Ù ÈξÀ ³ôÀ» °ÍÀ¸·Î ÆľÇÇÏ°í ÀÖ½À´Ï´Ù. ÃÖ¼ÒÇÑ 95%Á¤µµ ¾Æ´Ñ°¡ »ý°¢ÇÕ´Ï´Ù. °ËÁø ³»½Ã°æ¿¡¼­´Â training, quality control, outcome monitoringÀÌ ¸Å¿ì Áß¿äÇÕ´Ï´Ù.

[2018-6-23 Áú¹®] Çѱ¹ Á¤ºÎ°¡ ¿î¿µÇÏ°í ÀÖ´Â °ËÁø ÇÁ·Î±×·¥¿¡¼­ ÇÑ ¿¹ÀÇ À§¾ÏÀ» ã±â À§ÇÏ¿© ¾î´À Á¤µµÀÇ ºñ¿ëÀÌ ÇÊ¿äÇß½À´Ï±î?

[2018-6-23 ÀÌÁØÇà ´äº¯] Cost-effectiveness outcomes of the national gastric cancer screening program in South Korea (Asian Pac J Cancer Prev 2013)À» Âü°íÇϱ⠹ٶø´Ï´Ù. ´ë·« À§³»½Ã°æ 500°Ç¿¡ ÇÑ ¸íÀÇ À§¾ÏÀÌ ¹ß°ßµË´Ï´Ù. ÁøÁ¤, ¼Òµ¶, Á¶Á÷°Ë»ç, °ü¸®ºñ µîÀ» Á¦¿ÜÇÏ°í ¼ø¼öÇÏ°Ô ³»½Ã°æ °Ë»çºñ°¡ 50 US dollar Á¤µµÀÔ´Ï´Ù. ´Ü¼ø °è»êÀ» Çϸé À§¾Ï ȯÀÚ 1¸íÀ» °ü¸®Çϴµ¥ 25,000 USDÀÇ ³»½Ã°æ °Ë»çºñ°¡ ÇÊ¿äÇÕ´Ï´Ù.

[2021-6-1] °ËÁøÀÇ Ç÷¾×°Ë»ç °ü·Ã ¿©·¯ À̽´°¡ ÀÖ½À´Ï´Ù.

[2024-11-15]

2024-11-15. KDDW. NCSP ³»½Ã°æÀÇ Á¶Á÷°Ë»ç ºñÀ²Àº 30%


[References]

1) EndoTODAY ¾Ï°ËÁø cancer screening

2) ÀϺ»°ËÁø³»½Ã°æ °³Á¤¾È - [2015-8-10. ¾Öµ¶ÀÚÆíÁö] ³»½Ã°æ °á°úÁö¿¡´Â ¹è°æ À§Á¡¸·¿¡ ´ëÇؼ­ AGML, CAG, MG, NG, HG (hypertrophic), EG (flat vs. raised)¸¸ º¸°íÇϵµ·Ï ±âÁØÀÌ ¹Ù²î¾î¼­, ÃÖ±Ù ÀϺ»¿¡¼­´Â CSG¶ó°í ÀûÀ¸¸é °ÔÀ¸¸£°í ¹«½ÄÇÑ ÀÇ»ç·Î Ãë±Þ¹Þ´Â ºÐÀ§±â±îÁö Á¶¼ºµÇ°í ÀÖ´Ù°í ÇÕ´Ï´Ù.

3) 2018-4-14. Hp ÇÐȸ Meet the professor ¼¼¼Ç

PPT PDF 3.5M. "°Ç°­ °ËÁøÀº òÚã·üÕÀÇ ÝÕÒÇõ®´Ù"¶ó´Â concept·Î °­ÀÇ¿Í Åä·ÐÀ» ÇÏ¿´½À´Ï´Ù. íþáø´Â ¸ðµç »ç¶÷ÀÇ ²ÞÀÌÁö¸¸ çµßæÀº ÀÌ·ê ¼ö ¾ø½À´Ï´Ù. ÀÌ·ê ¼ö ¾ø´Â ²ÞÀ» ÇâÇÏ¿© ÀÔÁõµÇÁö ¾ÊÀº ÀÏÀ» ÇÏ´Ù°¡´Â ¿µ»ýÀº Ä¿³ç Àå¼ö¿¡µµ ÁöÀåÀÌ »ý±é´Ï´Ù. ÝÕÒÇÀÇ ²ÞÀ» À§ÇÏ¿© ¾Æ¹« Ç®À̳ª ¸Ô´Ù°¡´Â å·õ®Ã³·³ »ý±ä Ô¸õ®¸¦ ¸Ô°í ÀÏÂï Á×°Ô µÉÁö ¸ð¸¨´Ï´Ù. ³²ÀÇ å·õ®°¡ ³»°Ô´Â Ô¸õ®ÀÏ ¼öµµ ÀÖ½À´Ï´Ù. Áß¿äÇÑ °ÍÀº ñéé¼ÀÔ´Ï´Ù. BalanceÀÌÁö¿ä. ¹«¸®ÇÑ °ËÁøÀº »ý¸íÀ» ´ÜÃà½ÃÅ°±â ½±½À´Ï´Ù. »îÀÇ ÁúÀ» ÇöÀúÈ÷ ¶³¾î¶ß¸®±âµµ ÇÕ´Ï´Ù. ¼Óµµ¸¦ ÁÙÀԽôÙ. °ÇÁø »ì»ìÇսôÙ. (2018-4-14)

4) ¾Ï½ºÆ®·Õ - °Ç°­°ËÁø 2022. »ï¼º¼­¿ïº´¿ø ±èÅÂÁØ

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.