Jung Minsoo
Department of Health Science, Dongduk Women's University, Seoul, South Korea.
Curr Probl Cancer. 2017 Jan-Feb;41(1):71-79. doi: 10.1016/j.currproblcancer.2016.11.006. Epub 2016 Dec 20.
The purpose of this study was to examine overdiagnosis and overtreatment related to cancer screening and to review relevant reports and studies. A comprehensive search of peer-reviewed and gray literature was conducted for relevant studies published between January 2000 and December 2015 reporting breast, prostate, and thyroid cancer screening tests and overdiagnosis. This study revealed no dichotomy on where screening would lower risk or cause overdiagnosis and overtreatment. Many screening tests did both, that is, at population level, there were both benefit (decreased disease-specific mortality) and harm (overdiagnosis and overtreatment). Therefore, we need to consider a balanced argument with citations for the potential benefits of screening along with the harms associated with screening. Although the benefits and harms can only be tested through randomized trials, important data from cohort studies, diagnostic accuracy studies, and modeling work can help define the extent of benefits and harms in the population. The health care cycle that prompt patients to undergo periodic screening tests is self-reinforcing. In most developed countries, screening test recommendations encourage periodic testing. Therefore, patients are continuing their screening. It is necessary for patients to become wise consumers of screening tests and make decisions with their physicians regarding further testing and treatments.
本研究的目的是调查与癌症筛查相关的过度诊断和过度治疗情况,并回顾相关报告和研究。对2000年1月至2015年12月期间发表的关于乳腺癌、前列腺癌和甲状腺癌筛查试验及过度诊断的同行评审文献和灰色文献进行了全面检索。本研究表明,筛查在降低风险还是导致过度诊断和过度治疗方面并无二分法。许多筛查试验兼具两者,即在人群层面,既有益处(降低疾病特异性死亡率)也有危害(过度诊断和过度治疗)。因此,我们需要考虑一个平衡的观点,引用筛查的潜在益处以及与筛查相关的危害。虽然益处和危害只能通过随机试验来检验,但队列研究、诊断准确性研究和建模工作的重要数据有助于确定人群中益处和危害的程度。促使患者接受定期筛查试验的医疗保健周期是自我强化的。在大多数发达国家,筛查试验建议鼓励定期检测。因此,患者持续进行筛查。患者有必要成为明智的筛查试验消费者,并与医生就进一步检测和治疗做出决策。