What is overdiagnosis and why should we take it seriously in cancer screening?
What is overdiagnosis and why should we take it seriously in cancer screening?
复制标题
DOI：
10.17061/phrp2731722
复制
发表时间：
2017-07-01
影响因子：
4.4
通讯作者：
Barratt, Alexandra
中科院分区：
文献类型：
--
作者：
Carter, Stacy M.;Barratt, Alexandra
过度诊断发生在一个人群中，当条件被正确诊断，但诊断产生的利益和危害之间的不利平衡。在癌症筛查中，过度诊断的癌症是那些不需要被发现的癌症，因为它们不会产生症状或导致过早死亡。这些过度诊断的癌症可以与假阳性区分开来，假阳性发生在最初的筛查测试表明一个人处于高风险，但后续测试显示他们处于正常风险。最有可能通过筛查被过度诊断的癌症是前列腺、甲状腺、乳腺和肺癌。癌症筛查中的过度诊断在很大程度上源于一个矛盾的问题，即筛查最有可能发现最不可能伤害我们的缓慢生长或休眠的癌症，而不太可能发现导致癌症死亡的侵袭性快速生长的癌症。这一核心矛盾在近几十年来变得更加清晰。筛查计划产生的过度诊断越多，该计划就越不可能实现其减少癌症疾病和过早死亡的最终目标。因此，卫生专业人员和研究人员必须继续对过度诊断的程度和后果进行公开、科学的调查，并制定适当的应对措施。
Overdiagnosis occurs in a population when conditions are diagnosed correctly but the diagnosis produces an unfavourable balance between benefits and harms. In cancer screening, overdiagnosed cancers are those that did not need to be found because they would not have produced symptoms or led to premature death. These overdiagnosed cancers can be distinguished from false positives, which occur when an initial screening test suggests that a person is at high risk but follow-up testing shows them to be at normal risk. The cancers most likely to be overdiagnosed through screening are those of the prostate, thyroid, breast and lung. Overdiagnosis in cancer screening arises largely from the paradoxical problem that screening is most likely to find the slow-growing or dormant cancers that are least likely to harm us, and less likely to find the aggressive, fast-growing cancers that cause cancer mortality. This central paradox has become clearer over recent decades. The more overdiagnosis is produced by a screening program, the less likely the program is to serve its ultimate goal of reducing illness and premature death from cancer. Thus, it is vital that health professionals and researchers continue an open, scientific inquiry into the extent and consequences of overdiagnosis, and devise appropriate responses to it.