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국가 폐암 검진에 대한 반대 의견

National Lung Cancer Screening Program in Korea: More Harm Than Good

이정권|신상원
대한임상건강증진학회 (Korean Society For Health Promotion And Disease Prevention)|2019.12|Korean Journal of Health Promotion|제19권 제4호|pp. 166-170

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대한민국KoreaScreeningLung cancer폐암검진
주제분류기타자연과학

초록

고위험 흡연자를 대상으로 저선량 컴퓨터단층촬영(LDCT) 선별검사로 폐암 사망률을 20% 감소시킨다는 미국의 연구(NLST) 결과가 2011년 발표되었으나, 8년이 경과한 2019년폐암 검진을 국가 검진으로 채택하여 시행하는 의료 선진국은없다. 표준 의료 행위로 권유되고 있는 미국에서도 대상 환자의 LDCT screening의 수검률은 5% 이내로 극히 낮은 실정이다. 폐암 검진으로 인한 폐암 사망률 감소의 이득에도 불구하고 과도하게 높은 위양성으로 인한 신체적, 정신적, 경제적위해와 과잉진단으로 인한 불필요한 치료로 발생되는 위해의가능성 등에 대한 우려가 크다. 최근 폐암 검진의 효용성과위해성에 대한 논란이 가중되는 상황이며, 인공지능 등 새로운 첨단 기술을 이용한 새로운 폐암 검진 개발을 위한 연구가시작되는 추세이다. 최근 대한민국 정부는 기존의 미국 NLST 연구를 기반으로 한 LDCT 폐암 검진을 국가 암 검진으로채택하기 위하여 법을 개정하였다. 폐암 검진의 효과에 대한검증이 세계 의학계의 논란으로 가중되는 상황에서, 굳이 한국에서 세계 최초, 세계 유일의 폐암 검진을 많은 국민을 대상으로 시도하는 것은 현 시점에서는 무모하고 위험한 정책이라고 판단된다. 의도와는 다르게 흡연자뿐 아니라 전체 국민의건강에 커다란 위협이 될 가능성이 높다. 국가 폐암 검진은중단되어야 하며, 최소한 국내 환자를 대상으로 한 무작위연구를 먼저 실시하여 확실한 효과가 증명된 다음에야 실시하는 것이 적절할 것이다.

Abstract

Although the result of low dose computed tomography (LDCT) screening for high risk smoker for lung cancer (National Lung Screening Trial, NLST) showed 20% of lower lung cancer death compare to chest X-ray screening, which published in 2011, after more than 8 years passed, no European or Asian country has implemented organized lung cancer screening with LDCT, and there are no National Lung Cancer Screening Program globally. In United States, where LDCT lung screening has become standard procedure, the screening rate is extremely low, less than 5%. That is because in spite of the considerable the benefit of the screening, the harms of screening; specifically, most notably due to the high level of false positives, and physical, psychological, and economical burdens. Recently the controversies regarding the harms of LDCT lung screening has been increasingly debated. Also, the novel strategies, such as artificial intelligence and volumetric measurement of suspicious nodules has been adopted for recently launched lung cancer screening clinical trials. However, amid of skeptical opinions increasing globally, Korean Government recently decided to include LDCT lung cancer screening as national cancer screening program, becoming Korea as the first and the only national lung cancer screening program worldwide. Without randomized trial proven to be effective for Korea population, hurried implementation of national lung cancer screening program could have more harmful effect than benefit in terms of public health perspectives.

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