Division of Urology, University of Toronto, Toranto, Ontario, Canada.
Curr Opin Urol. 2012 May;22(3):203-9. doi: 10.1097/MOU.0b013e32835259aa.
Overdiagnosis has become a major problem in medicine in general and cancer in particular. This is a summary of this problem.
Because of earlier detection, the nature of cancer has changed, from a disease usually diagnosed at a late and incurable stage to a heterogeneous condition that varies from clinically insignificant to rapidly aggressive. Screening programs for cancer have resulted in a dramatic increase in the diagnosis of clinically insignificant disease, balanced by improved survival and mortality because of significant cancers being diagnosed at a more curable stage. Overdiagnosis requires the presence of microfocal disease and a screening test to identify this. This exists for breast, prostate, and thyroid cancers, and to a lesser degree for renal and lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous causes and many trade-offs. It is particularly important in prostate cancer, but is a major issue in many other cancer sites. Screening for prostate cancer appears, based on the best data from randomized trials, to significantly reduce cancer mortality.
Reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening.
过度诊断已成为医学（尤其是癌症）领域的一个主要问题。本文对该问题进行了总结。
由于早期检测，癌症的性质发生了变化，从通常在晚期和不可治愈阶段诊断的疾病转变为具有异质性的疾病，从临床无意义到快速侵袭性不等。癌症筛查计划导致临床上无意义疾病的诊断显著增加，但由于更多可治愈阶段诊断出更严重的癌症，生存率和死亡率有所提高。过度诊断需要存在微小病灶和能够识别这种病灶的筛查试验。这在乳腺癌、前列腺癌和甲状腺癌中存在，在一定程度上在肾癌和肺癌中也存在。癌症过度诊断和过度治疗的问题很复杂，有许多原因和许多权衡。在前列腺癌中尤为重要，但在许多其他癌症部位也是一个主要问题。基于随机试验的最佳数据，前列腺癌筛查似乎显著降低了癌症死亡率。
减少诊断为惰性疾病患者的过度治疗对于筛查的成功至关重要。
