Statistician, Clinical and Descriptive Epidemiology Unit, ISPO – Cancer Research and Prevention Institute, Florence, Italy
J Med Screen. 2012;19 Suppl 1:42-56. doi: 10.1258/jms.2012.012082.
Overdiagnosis, the detection through screening of a breast cancer that would never have been identified in the lifetime of the woman, is an adverse outcome of screening. We aimed to determine an estimate range for overdiagnosis of breast cancer in European mammographic service screening programmes.
We conducted a literature review of observational studies that provided estimates of breast cancer overdiagnosis in European population-based mammographic screening programmes. Studies were classified according to the presence and the type of adjustment for breast cancer risk (data, model and covariates used), and for lead time (statistical adjustment or compensatory drop). We expressed estimates of overdiagnosis from each study as a percentage of the expected incidence in the absence of screening, even if the variability in the age range of the denominator could not be removed. Estimates including carcinoma in situ were considered when available.
There were 13 primary studies reporting 16 estimates of overdiagnosis in seven European countries (the Netherlands, Italy, Norway, Sweden, Denmark, UK and Spain). Unadjusted estimates ranged from 0% to 54%. Reported estimates adjusted for breast cancer risk and lead time were 2.8% in the Netherlands, 4.6% and 1.0% in Italy, 7.0% in Denmark and 10% and 3.3% in England and Wales.
The most plausible estimates of overdiagnosis range from 1% to 10%. Substantially higher estimates of overdiagnosis reported in the literature are due to the lack of adjustment for breast cancer risk and/or lead time.
过度诊断是指通过筛查检测到在女性一生中永远不会被发现的乳腺癌，是筛查的一种不利后果。我们旨在确定欧洲乳腺筛查服务计划中乳腺癌过度诊断的估计范围。
我们对提供欧洲基于人群的乳腺筛查计划中乳腺癌过度诊断估计的观察性研究进行了文献回顾。根据是否存在和调整乳腺癌风险的数据、模型和协变量）以及是否存在领先时间（统计调整或补偿下降）对研究进行了分类。我们将每个研究的过度诊断估计表示为在没有筛查的情况下预期发病率的百分比，即使无法消除分母年龄范围的可变性。在可用的情况下，包括原位癌的估计数。
有 13 项主要研究报告了来自七个欧洲国家（荷兰、意大利、挪威、瑞典、丹麦、英国和西班牙）的 16 项过度诊断估计数。未经调整的估计数范围从 0%到 54%。经过乳腺癌风险和领先时间调整的报告估计数分别为荷兰的 2.8%，意大利的 4.6%和 1.0%，丹麦的 7.0%以及英格兰和威尔士的 10%和 3.3%。
最合理的过度诊断估计数在 1%到 10%之间。文献中报告的过度诊断的估计数要高得多，这是由于缺乏对乳腺癌风险和/或领先时间的调整。
