检测筛选乳腺癌中更多的小癌症表明过度诊断

Screening mammography was associated with increased diagnosis of small cancers in a study across U.S. counties but not with significant changes in breast cancer deaths or a decreased incidence of larger breast cancers, which researchers suggest may be the result of overdiagnosis, according to an article published online by贾马内科。

目标的目标筛选乳房X线照片是通过在疾病过程中早期检测和治疗癌症来减少乳腺癌死亡。如果筛选早期检测肿瘤，较小和更具可治疗的癌症的诊断应增加，而较大且可治疗的癌症的诊断应减少。然而，越来越多的疑虑通过鉴定在临床上不会变得明显的少量，惰性或回归肿瘤，筛选无意地导致过度诊断。

Richard Wilson，D.Phil。，哈佛大学，剑桥大学，萨桥，同建事业和共同队伍进行了40岁及以上的1900万岁及以上的生态研究，他们在2000年期间报告了547个县，在2000年期间报告了监测，流行病学和最终结果癌症注册表。这些女性，当年，53,207次被诊断出患有乳腺癌，并随后未来10年。

作者检测了每个县的筛查程度，并在10年的随访期间测量了2000年的乳腺癌发病和基于发病的乳腺癌死亡，每个县都计算了发病率和死亡率。

作者发现，跨县的筛查和乳腺癌发病程度之间存在相关性，但没有乳腺癌死亡率。筛选程度上增加了10个百分点与16％的乳腺癌诊断有关，但乳腺癌死亡的显着变化没有显着变化。

根据结果​​，更多的筛选也与2厘米或更小的小乳腺癌的发病率增加有关，但没有较大的乳腺癌发生率降低。筛查中增加了10个百分点，小乳腺癌发病率增加了25％，较大乳腺癌发病率增加7％。

"Across U.S. counties, the data show that the extent of screening mammography is indeed associated with an increased incidence of small cancers but not with decreased incidence of larger cancers or significant differences in mortality. ... What explains the observed data? The simplest explanation is widespread overdiagnosis, which increases the incidence of small cancers without changing mortality, and therefore matches every feature of the observed data," the authors conclude.

然而，作者注意临床医生因生态谬论而谨慎为生态学研究，这是对统计分析中的群体数据中的个体的推论，因为个人可能没有这些特征。

“通常情况下，筛选的情况如此，当筛选被引导到高风险时的效益和危害的平衡可能是最有利的，这两者都没有过于频繁，也不是太少，有时候等待而不是立即活跃治疗，“研究结束了。

In a related commentary, Joann G. Elmore, M.D., M.P.H., of the University of Washington, Seattle, and Ruth Etzioni, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, write: "However, much has also been written about the caution needed when interpreting ecological analyses. It is well known, for example, that ecological studies provide no information as to whether the people who were actually exposed to the intervention were the same people who developed the disease, whether the exposure or the onset of disease came first, or whether there are other explanations for the observed association."

“我们需要明确的沟通和更好的工具来帮助女性做出明智的决定乳腺癌筛选乳房X线照片。......也许最重要的是，我们需要了解如何与患者沟通有关我们科学知识的不确定性和限制。最后，我们都需要对女性感到舒服，我们不知道过度诊断的实际量大，精确度。作者结束了，知情决策的一部分是提供所有信息，即使我们的不确定性，“

---

---