基于人群的乳腺癌筛查中浸润性乳腺癌的过度诊断：短期和长期观点。

Overdiagnosis of invasive breast cancer in population-based breast cancer screening: A short- and long-term perspective.

机构信息

Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium.

Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

出版信息

Eur J Cancer. 2022 Sep;173:1-9. doi: 10.1016/j.ejca.2022.06.027. Epub 2022 Jul 12.

DOI:10.1016/j.ejca.2022.06.027

PMID:35839596

Abstract

BACKGROUND

Overdiagnosis of invasive breast cancer (BC) is a contentious issue.

OBJECTIVE

The aim of this paper is to estimate the overdiagnosis rate of invasive BC in an organised BC screening program and to evaluate the impact of age and follow-up time.

METHODS

The micro-simulation model SiMRiSc was calibrated and validated for BC screening in Flanders, where women are screened biennially from age 50 to 69. Overdiagnosis rate was defined as the number of invasive BC that would not have been diagnosed in the absence of screening per 100,000 screened women during the screening period plus follow-up time (which was set at 5 years and varied from 2 to 15 years). Overdiagnosis rate was calculated overall and stratified by age.

RESULTS

The overall overdiagnosis rate for women screened biennially from 50 to 69 was 20.1 (95%CI: 16.9-23.2) per 100,000 women screened at 5-year follow-up from stopping screening. Overdiagnosis at 5-year follow-up time was 12.9 (95%CI: 4.6-21.1) and 74.2 (95%CI: 50.9-97.5) per 100,000 women screened for women who started screening at age 50 and 68, respectively. At 2- and 15-year follow-up time, overdiagnosis rate was 98.5 (95%CI: 75.8-121.3) and 13.4 (95%CI: 4.9-21.9), respectively, for women starting at age 50, and 297.0 (95%CI: 264.5-329.4) and 34.2 (95%CI: 17.5-50.8), respectively, for those starting at age 68.

CONCLUSIONS

Sufficient follow-up time (≥10 years) after screening stops is key to obtaining unbiased estimates of overdiagnosis. Overdiagnosis of invasive BC is a larger problem in older compared to younger women.

摘要

背景

过度诊断浸润性乳腺癌（BC）是一个有争议的问题。

目的

本文旨在评估组织性 BC 筛查项目中浸润性 BC 的过度诊断率，并评估年龄和随访时间的影响。

方法

使用微模拟模型 SiMRiSc 对佛兰德的 BC 筛查进行校准和验证，在该地区，女性从 50 岁到 69 岁每两年接受一次筛查。过度诊断率定义为在没有筛查的情况下，每 10 万名接受筛查的女性在筛查期和随访期（设定为 5 年，从 2 年到 15 年不等）内诊断出的浸润性 BC 数量。总体过度诊断率和按年龄分层的过度诊断率均进行了计算。

结果

从 50 岁开始每两年接受一次筛查，在停止筛查后 5 年随访时，每 10 万名女性的总体过度诊断率为 20.1（95%CI：16.9-23.2）。5 年随访时的过度诊断率为 12.9（95%CI：4.6-21.1）和 74.2（95%CI：50.9-97.5），分别为 50 岁和 68 岁开始筛查的女性每 10 万名女性的过度诊断率。在 2 年和 15 年随访时，对于 50 岁开始筛查的女性，过度诊断率分别为 98.5（95%CI：75.8-121.3）和 13.4（95%CI：4.9-21.9），对于 68 岁开始筛查的女性，过度诊断率分别为 297.0（95%CI：264.5-329.4）和 34.2（95%CI：17.5-50.8）。