Chen Yunchan, Gutierrez Valeria, Morris Luc, Marti Jennifer L
Department of Surgery, Weill Cornell Medicine, New York, USA.
Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA.
Cureus. 2023 Jul 25;15(7):e42439. doi: 10.7759/cureus.42439. eCollection 2023 Jul.
Certain medical diagnoses and environmental or occupational exposures may be associated with elevated risk of cancer diagnosis, either through causal mechanisms or via increased detection of a subclinical reservoir through increased diagnostic scrutiny (overdiagnosis). The present study aimed to investigate the distribution of elevated cancer risks associated with different diagnoses and exposures. A systematic literature search was conducted to identify studies published in the last 30 years that examined the standardized incidence ratio (SIR) associated with exposures and risk factors. Meta-SIRs for each cancer type were calculated. The distribution of elevated cancer risks was then compared between cancer types previously reported to be susceptible to overdiagnosis and those that have not been associated with overdiagnosis. The review of 108 studies identified four patterns: SIR generally elevated for 1) only overdiagnosis-susceptible cancer types, 2) both overdiagnosed and non-overdiagnosed cancer types, 3) select cancers in accordance with risk factor or exposure, and 4) SIRs that did not exhibit a distinct increase in any cancer type. The distribution of elevated cancer risks may serve as a signature of whether the underlying risk factor or exposure is a carcinogenic process or a mechanism of increased diagnostic scrutiny uncovering clinically occult diseases. The identification of increased cancer risk should be viewed with caution, and analyzing the pattern of elevated cancer risk distribution can potentially reveal conditions that appear to be cancer risk factors but are in fact the result of exposure to medical surveillance or other healthcare activities that lead to the detection of indolent tumors.
某些医学诊断以及环境或职业暴露可能与癌症诊断风险升高相关，其途径要么是通过因果机制，要么是通过加强诊断检查（过度诊断）增加对亚临床病灶的检测。本研究旨在调查与不同诊断和暴露相关的癌症风险升高的分布情况。进行了一项系统的文献检索，以识别过去30年发表的研究，这些研究考察了与暴露和风险因素相关的标准化发病比（SIR）。计算了每种癌症类型的Meta-SIR。然后比较了先前报告易发生过度诊断的癌症类型与那些与过度诊断无关的癌症类型之间癌症风险升高的分布情况。对108项研究的综述确定了四种模式：SIR通常在以下情况升高：1）仅针对易发生过度诊断的癌症类型，2）既包括过度诊断的癌症类型也包括未过度诊断的癌症类型，3）根据风险因素或暴露情况选择的癌症，4）在任何癌症类型中SIR均未出现明显升高。癌症风险升高的分布情况可作为一种特征，表明潜在的风险因素或暴露是致癌过程还是增加诊断检查从而发现临床隐匿疾病的机制。对于癌症风险增加的识别应谨慎看待，分析癌症风险升高分布的模式可能会揭示那些看似是癌症风险因素，但实际上是因接受医学监测或其他医疗活动导致惰性肿瘤被检测出来的情况。
