Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis
Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis
复制标题
DOI：
10.1093/jnci/djj207
复制
发表时间：
2006-06-07
期刊：
影响因子：
--
通讯作者：
Fontana, RS
中科院分区：
文献类型：
--
作者：
Marcus, PM;Bergstralh, EJ;Fontana, RS
背景。癌症筛查的一个令人不安的方面是可能出现过度诊断，即检测出在没有筛查的情况下永远不会被诊断出来的疾病。过度诊断在肺癌筛查中尤其令人担忧，因为更新的筛查方式可以识别临床意义未知的小结节。此前发表的梅奥肺项目数据分析表明，肺癌筛查中可能存在过度诊断的情况，该项目是 20 世纪 70 年代和 80 年代初在 9211 名男性吸烟者中进行的一项大型随机对照试验。随访结束时（1983 年 7 月 1 日），未观察到肺癌死亡率存在差异，但干预组中超过 46 例病例表明过度诊断。由于这种过量可能是由于随访时间短造成的，因此我们通过进行长期肺癌发病率随访来调查这种可能性。方法：我们通过医疗记录、邮寄给参与者或近亲的调查以及州死亡证明，调查了 7118 名梅奥肺项目参与者 1999 年的肺癌状况，这些参与者在 1983 年仍然活着，但没有诊断出肺癌。结果：提供了 6101 名参与者的信息，其中 811 名参与者的肺癌状况不确定。从1971年11月到1999年12月31日，干预组的585名参与者和常规治疗组的500名参与者被诊断患有肺癌。结论：经过 16 年的随访，干预组中持续出现过多病例，为肺癌筛查中的过度诊断提供了持续的支持。
Background. A troubling aspect of cancer screening is the potential for overdiagnosis, i.e., detection of disease that, in the absence of screening, would never have been diagnosed. Overdiagnosis is of particular concern in lung cancer screening because newer screening modalities can identify small nodules of unknown clinical significance. Previously published analyses of data from the Mayo Lung Project, a large randomized controlled trial conducted among 9211 male cigarette smokers in the 1970s and early 1980s indicated that overdiagnosis might exist in lung cancer screening. At the end of follow-up (July 1, 1983), no difference in lung cancer mortality was observed, but an excess of 46 cases in the intervention arm suggested overdiagnosis. Because that excess could instead have resulted from short follow-up time, we investigated this possibility by conducting long-term lung cancer incidence follow-up. Methods: We investigated the lung cancer status through 1999 of the 7118 participants in the Mayo Lung Project who were alive and without diagnosed lung cancer in 1983 by use of medical records, surveys mailed to participants or next-of-kin, and state death certificates. Results: Information was available for 6101 participants, including 811 with inconclusive lung cancer status. From November 1971 through December 31, 1999, 585 participants in the intervention arm and 500 in the usual-care arm were diagnosed with lung cancer. Conclusions: The persistence of excess cases in the intervention arm after 16 additional years of follow-up provides continued support for overdiagnosis in lung cancer screening.