Welch H Gilbert, Woloshin Steven, Schwartz Lisa M
VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
BMJ. 2005 Sep 3;331(7515):481. doi: 10.1136/bmj.38516.649537.E0. Epub 2005 Aug 4.
To describe changes in skin biopsy rates and to determine their relation with changes in the incidence of melanoma.
Population based ecological study.
Nine geographical areas of the United States.
Participants of the Surveillance Epidemiology and End Results (SEER) programme aged 65 and older.
For the period 1986 to 2001, annual skin biopsy rates for each surveillance area from Medicare claims and incidence rates for melanoma for the same population.
Between 1986 and 2001 the average biopsy rate across the nine participating areas increased 2.5-fold among people aged 65 and older (2847 to 7222 per 100,000 population). Over the same period the average incidence of melanoma increased 2.4-fold (45 to 108 per 100,000 population). Assuming that the occurrence of true disease was constant, the extra number of melanoma cases that were diagnosed after carrying out 1000 additional biopsies was 12.6 (95% confidence interval 11.2 to 14.0). After controlling for a potential increase in the true occurrence of disease, 1000 additional biopsies were still associated with 6.9 (3.1 to 10.8) extra melanoma cases diagnosed. Stage specific analyses suggested that 1000 biopsies were associated with 4.4 (2.1 to 6.8) extra cases of in situ melanoma diagnosed and 2.3 (0.0 to 4.6) extra cases of local melanoma, but not with the incidence of advanced melanoma. Mortality from melanoma changed little during the period.
The incidence of melanoma is associated with biopsy rates. That the extra cases diagnosed were confined to early stage cancer while mortality remained stable suggests overdiagnosis-the increased incidence being largely the result of increased diagnostic scrutiny and not an increase in the incidence of disease.
描述皮肤活检率的变化,并确定其与黑色素瘤发病率变化的关系。
基于人群的生态学研究。
美国九个地理区域。
监测、流行病学和最终结果(SEER)计划中65岁及以上的参与者。
1986年至2001年期间,每个监测区域根据医疗保险索赔得出的年度皮肤活检率以及同一人群的黑色素瘤发病率。
1986年至2001年期间,九个参与区域中65岁及以上人群的平均活检率增长了2.5倍(从每10万人2847例增至7222例)。同期,黑色素瘤的平均发病率增长了2.4倍(从每10万人45例增至108例)。假设真正疾病的发生率不变,每额外进行1000次活检后被诊断出的额外黑色素瘤病例数为12.6例(95%置信区间为11.2至14.0)。在控制了疾病真正发生率的潜在增加后,每额外进行1000次活检仍与6.9例(3.1至10.8例)额外被诊断出的黑色素瘤病例相关。按分期进行的分析表明,1000次活检与4.4例(2.1至6.8例)额外被诊断出的原位黑色素瘤病例以及2.3例(0.0至4.6例)额外的局部黑色素瘤病例相关,但与晚期黑色素瘤的发病率无关。在此期间,黑色素瘤死亡率变化不大。
黑色素瘤的发病率与活检率相关。被诊断出的额外病例局限于早期癌症,而死亡率保持稳定,这表明存在过度诊断——发病率增加主要是诊断检查增加的结果,而非疾病发病率上升。