Unidad de Radiofísica, Hospital Univ. San Cecilio, Granada, Spain.
Servicio de Física y Protección Radiológica, Hospital Reg. Univ. Virgen de las Nieves, Granada, Spain.
BMJ Open. 2019 Feb 19;9(2):e023187. doi: 10.1136/bmjopen-2018-023187.
To build up and test a Monte Carlo simulation procedure for the investigation of overdiagnosis in breast screening programmes (BSPs).
A Monte Carlo tool previously developed has been adapted for obtaining the quantities of interest in order to determine the overdiagnosis: the annual and cumulative number of cancers detected by screening, plus interval cancers, for a population following the BSP, and detected clinically for the same population in the absence of screening. Overdiagnosis is obtained by comparing these results in a direct way.
Overdiagnosis between 7% and 20%, depending on the specific configuration of the programme, have been found. These range of values is in agreement with some of the results available for actual BSPs. In the cases analysed, a reduction of 11% at most has been found in the number of invasive tumours detected by screening in comparison to those clinically detected in the control population. It has been possible to establish that overdiagnosis is almost entirely linked to ductal carcinoma in situ tumours.
The use of Monte Carlo tools may facilitate the analysis of overdiagnosis in actual BSPs, permitting to address the role played by various quantities of relevance for them.
建立并测试用于研究乳腺筛查计划（BSP）中过度诊断的蒙特卡罗模拟程序。
先前开发的蒙特卡罗工具已进行了调整，以获取感兴趣的数量，从而确定过度诊断：在遵循 BSP 的人群中通过筛查检测到的年度和累积癌症数量，以及在没有筛查的情况下为同一人群临床检测到的间隔性癌症。通过直接比较这些结果来获得过度诊断。
根据计划的特定配置，发现过度诊断率在 7%到 20%之间。这些范围的值与实际 BSP 的一些结果一致。在所分析的病例中，与对照人群中临床检测到的肿瘤相比，筛查检测到的浸润性肿瘤数量最多减少了 11%。已经可以确定，过度诊断几乎完全与导管原位癌肿瘤有关。
使用蒙特卡罗工具可以方便地分析实际 BSP 中的过度诊断，从而确定它们的各种相关数量所起的作用。
