Gocko X, Leclerq M, Plotton C
Faculté de médecine générale de Saint-Étienne, université Jacques-Lisfranc, campus santé innovations, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France; Laboratoire SNA-EPIS EA4607, 42055 Saint-Etienne cedex 2, France; Health Services and Performance Research (HESPER), EA7425, 42055 Saint-Etienne cedex 2, France.
Faculté de médecine générale de Saint-Étienne, université Jacques-Lisfranc, campus santé innovations, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France.
Rev Epidemiol Sante Publique. 2018 Nov;66(6):395-403. doi: 10.1016/j.respe.2018.08.007. Epub 2018 Oct 11.
The risk-benefit ratio of breast cancer organized screening is the focus of much scientific controversy, especially about overdiagnosis. The aim of this study was to relate methodological discrepancies to variations in rates of overdiagnosis to help build future decision aids and to better communicate with patients.
A systematic review of methodology was conducted by two investigators who searched Medline and Cochrane databases from 01/01/2004 to 12/31/2016. Results were restricted to randomized controlled trials (RCTs) and observational studies in French or English that examined the question of the overdiagnosis computation.
Twenty-three observational studies and four RCTs were analyzed. The methods used comparisons of annual or cumulative incidence rates (age-cohort model) in populations invited to screen versus non-invited populations. Lead time and ductal carcinoma in situ (DCIS) were often taken into account. Some studies used statistical modeling based on the natural history of breast cancer and gradual screening implementation. Adjustments for lead time lowered the rate of overdiagnosis. Rate discrepancies, ranging from 1 to 15 % for some authors and around 30 % for others, could be explained by the hypotheses accepted concerning very slow growing tumors or tumors that regress spontaneously.
Apparently, research has to be centered on the natural history of breast cancer in order to provide responses concerning the questions raised by the overdiagnosis controversy.
乳腺癌组织筛查的风险效益比是众多科学争议的焦点，尤其是关于过度诊断。本研究的目的是将方法学差异与过度诊断率的变化联系起来，以帮助构建未来的决策辅助工具，并更好地与患者沟通。
两名研究人员对方法学进行了系统评价，他们检索了2004年1月1日至2016年12月31日的Medline和Cochrane数据库。结果仅限于以法语或英语发表的、研究过度诊断计算问题的随机对照试验（RCT）和观察性研究。
分析了23项观察性研究和4项RCT。所使用的方法是比较受邀筛查人群与未受邀人群的年度或累积发病率（年龄队列模型）。通常会考虑领先时间和原位导管癌（DCIS）。一些研究使用基于乳腺癌自然史和逐步实施筛查的统计模型。对领先时间的调整降低了过度诊断率。某些作者报告的比率差异为1%至15%，而其他作者报告的比率约为30%，这可以用关于生长非常缓慢的肿瘤或自发消退的肿瘤的假设来解释。
显然，研究必须以乳腺癌的自然史为中心，以便回答过度诊断争议所提出的问题。
