Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave. #MG408, Toronto, ON, M4N 3M5, Canada.
World J Urol. 2022 Jan;40(1):1-8. doi: 10.1007/s00345-020-03523-2. Epub 2021 Jan 25.
Cancer, which historically was diagnosed at late and incurable stages, has expanded to a heterogeneous group of conditions that vary from clinically insignificant to rapidly aggressive and lethal. This evolution is due to the widespread use of screening tests for early detection of cancer, both directed (i.e., PSA, mammography, colonoscopy) and undirected (abdominal imaging). The use of these tests has resulted in both benefits and harms. The benefits are a reduction in survival and mortality, due to significant cancers being diagnosed at a more curable stage. The harms are an increase, in some cases dramatic, in the diagnosis of clinically insignificant disease. These are called 'cancer' but not destined to affect the patient's life, even in the absence of treatment.
Non-explicit summary of the literature on overdiagnosis of cancer.
The phenomenon of overdiagnosis requires two factors: the presence of a common reservoir of microfocal disease and a screening test to find it. These factors exist for breast, prostate, skin, renal, and thyroid cancers, and to a lesser degree for lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous etiologies and many tradeoffs. It is a particular problem in prostate cancer but is a major issue in many other cancer sites. Screening for prostate cancer based on the best data from prospective randomized trials significantly reduces cancer mortality. However, reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening.
Active surveillance, the focus of this series of articles, is an important strategy to reduce overtreatment. This article reviews the pathological, clinical, social, and psychological aspects of overdiagnosis in cancer.
癌症在过去常常被诊断为晚期且无法治愈的疾病，但现在已经扩展为一组异质性疾病，其严重程度从无临床意义到快速侵袭性和致命性不等。这种演变是由于广泛使用筛查试验来早期发现癌症，包括有针对性的（例如 PSA、乳房 X 光检查、结肠镜检查）和非针对性的（腹部成像）。这些测试的使用既带来了益处，也带来了危害。益处是由于更多的可治愈阶段的显著癌症得到诊断，从而降低了生存率和死亡率。危害是在某些情况下，诊断出无临床意义疾病的数量显著增加。这些被称为“癌症”，但即使没有治疗，也不一定会影响患者的生命。
对癌症过度诊断文献的非明确性总结。
过度诊断的现象需要两个因素：存在常见的微灶性疾病库和发现它的筛查试验。这些因素存在于乳腺癌、前列腺癌、皮肤癌、肾癌和甲状腺癌中，在肺癌中程度较轻。癌症过度诊断和过度治疗的问题很复杂，有许多病因和许多权衡。在前列腺癌中，这是一个特殊的问题，但在许多其他癌症部位也是一个主要问题。基于前瞻性随机试验的最佳数据进行前列腺癌筛查，显著降低了癌症死亡率。然而，减少对诊断为惰性疾病的患者的过度治疗，对于筛查的成功至关重要。
主动监测是本系列文章的重点，是减少过度治疗的重要策略。本文综述了癌症过度诊断的病理、临床、社会和心理方面。
