Acting in the Face of Uncertainty
A partir d'une revue systématique de la littérature publiée jusqu'en avril 2014 (22 études), cet article évalue les bénéfices, en termes de survie, et les risques associés à un dépistage en routine du carcinome hépatocellulaire chez les patients présentant une maladie hépatique chronique
The Achilles' heel of evidence-based medicine is that the state of evidence for many common clinical interventions is not sufficient to either confirm or refute their benefits. Screening for hepatocellular carcinoma (HCC) in high-risk patients with cirrhosis is recommended by guidelines from the American Association for the Study of Liver Diseases (1) and is practiced in many parts of our health care system (the Veterans Health Administration [VHA]). Data from the VHA indicate that 56% of the approximately 25 000 patients with cirrhosis and chronic hepatitis C under VHA care in 2013 received at least 1 imaging test within the past 12 months. Yet, as noted in the review by Kansagara and colleagues in this issue (2), the evidence of the mortality benefit of screening remains insufficient to make a strong recommendation for or against screening. We oversee different areas relevant to this clinical puzzle at the VHA: health services research, care for high-risk patients with viral hepatitis, and oncology services. Although our individual perspectives undoubtedly shape our opinions about what to do in the face of uncertainty, we agree on much of the evidence, what research might be useful, and the policy options we need to consider while waiting for better evidence...
Annals of Internal Medicine , éditorial en libre accès, 2013