Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands.
Dutch Reference Center for Screening, Nijmegen, The Netherlands.
Int J Cancer. 2015 Aug 15;137(4):921-9. doi: 10.1002/ijc.29452. Epub 2015 Feb 5.
A drawback of early detection of breast cancer through mammographic screening is the diagnosis of breast cancers that would never have become clinically detected. This phenomenon, called overdiagnosis, is ideally quantified from the breast cancer incidence of screened and unscreened cohorts of women with follow-up until death. Such cohorts do not exist, requiring other methods to estimate overdiagnosis. We are the first to quantify overdiagnosis from invasive breast cancer and ductal carcinoma in situ (DCIS) in birth cohorts using an age-period-cohort -model (APC-model) including variables for the initial and subsequent screening rounds and a 5-year period after leaving screening. Data on the female population and breast cancer incidence were obtained from Statistics Netherlands, "Stichting Medische registratie" and the Dutch Cancer Registry for women aged 0-99 years. Data on screening participation was obtained from the five regional screening organizations. Overdiagnosis was calculated from the excess breast cancer incidence in the screened group divided by the breast cancer incidence in presence of screening for women aged 20-99 years (population perspective) and for women in the screened-age range (individual perspective). Overdiagnosis of invasive breast cancer was 11% from the population perspective and 17% from the invited women perspective in birth cohorts screened from age 49 to 74. For invasive breast cancer and DCIS together, overdiagnosis was 14% from population perspective and 22% from invited women perspective. A major strength of an APC-model including the different phases of screening is that it allows to estimate overdiagnosis in birth cohorts, thereby preventing overestimation.
通过乳腺 X 光筛查早期发现乳腺癌的一个缺点是诊断出原本不会在临床上被发现的乳腺癌。这种现象称为过度诊断，理想情况下可以通过对经过乳腺 X 光筛查和未经筛查的女性队列进行随访，直到死亡，来从乳腺癌发病率中进行量化。但这些队列并不存在，因此需要其他方法来估计过度诊断。我们是第一个使用年龄-时期-队列模型（APC 模型），包括初始和后续筛查轮次以及离开筛查后的 5 年期间的变量，从出生队列中对浸润性乳腺癌和导管原位癌（DCIS）的过度诊断进行量化的人。女性人口和乳腺癌发病率数据来自荷兰统计局、“Stichting Medische registratie”和荷兰癌症登记处，年龄为 0-99 岁的女性。筛查参与数据来自五个区域筛查组织。通过将筛查组中多余的乳腺癌发病率除以存在筛查的女性（20-99 岁人群，从人群角度）和筛查年龄组内的女性（从个体角度）的乳腺癌发病率，计算出过度诊断。从人群角度来看，从 49 岁到 74 岁筛查的出生队列中，浸润性乳腺癌的过度诊断率为 11%，从邀请女性角度来看为 17%。从人群角度来看，浸润性乳腺癌和 DCIS 一起的过度诊断率为 14%，从邀请女性角度来看为 22%。一个包括不同筛查阶段的 APC 模型的主要优势在于，它可以在出生队列中估计过度诊断，从而避免过度估计。
