Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMJ Evid Based Med. 2024 Jan 19;29(1):17-28. doi: 10.1136/bmjebm-2023-112341.
We aimed to systematically identify and scrutinise published empirical evidence about overdiagnosis in malignant melanoma and examine how frequent overdiagnosis of melanoma is and whether this is related to different types of interventions or diagnostic technologies.
Empirical studies that discussed overdiagnosis in malignant melanoma were eligible, including qualitative and quantitative studies in any type of population, age group and geographical location. We excluded studies that did not include empirical data, studies that only mentioned 'overdiagnosis' without addressing it further and studies that used the term overdiagnosis for cases of misdiagnosis or false positives.We developed the search strategy in cooperation with an information specialist. We searched five databases on 21 April 2022: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Library.This scoping review adheres to The JBI methodology and Prefered Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping reviews (PRISMA-ScR). Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data from the included studies. The data extracted include study characteristics, population details, research question, the context and the study's main results.
Our search resulted in 1134 potentially relevant studies. 35 studies were included: 29 register studies, 3 cohort studies, 1 case-control study, 1 survey study and 1 randomised controlled trial. Most register studies examined trends in melanoma incidence and/or mortality and found a significant increase in incidence between 0.39% and 6.6% annually and a little or no increase in mortality. Three cohort studies and one case-control study showed that skin screening was associated with increased detection of melanoma; especially in situ or thin invasive melanoma. Three studies estimated the degree of overdiagnosis which ranged from 29% to 60%.
Epidemiological data suggest a high degree of overdiagnosis in malignant melanoma. Studies that examined the association between skin screening and malignant melanoma all found increased detection of melanomas, mostly thin and in situ melanomas, which raises concern about overdiagnosis.
我们旨在系统地识别和审查已发表的关于恶性黑色素瘤过度诊断的实证证据，并探讨黑色素瘤过度诊断的频率及其与不同类型的干预或诊断技术的关系。
合格的研究包括在任何类型的人群、年龄组和地理位置中讨论恶性黑色素瘤过度诊断的定性和定量研究。我们排除了未包含实证数据的研究、仅提及“过度诊断”而未进一步探讨的研究以及将过度诊断一词用于误诊或假阳性病例的研究。我们与信息专家合作制定了搜索策略。我们于 2022 年 4 月 21 日在五个数据库中进行了搜索：MEDLINE、Embase、CINAHL、PsycINFO 和 Cochrane Library。本范围综述符合 JBI 方法学和系统评价和荟萃分析扩展的首选报告项目（PRISMA-ScR）。两名评审员独立筛选标题、摘要和全文以确定纳入标准，并从纳入的研究中提取数据。提取的数据包括研究特征、人群详细信息、研究问题、背景和研究的主要结果。
我们的搜索结果产生了 1134 篇潜在相关研究。35 项研究被纳入：29 项登记研究、3 项队列研究、1 项病例对照研究、1 项调查研究和 1 项随机对照试验。大多数登记研究都检查了黑色素瘤发病率和/或死亡率的趋势，发现发病率每年以 0.39%至 6.6%的速度显著增加，而死亡率几乎没有增加或略有增加。三项队列研究和一项病例对照研究表明，皮肤筛查与黑色素瘤的检出率增加有关；尤其是原位或薄侵袭性黑色素瘤。三项研究估计了过度诊断的程度，范围从 29%到 60%。
流行病学数据表明恶性黑色素瘤存在高度的过度诊断。检查皮肤筛查与恶性黑色素瘤之间关系的研究都发现黑色素瘤的检出率增加，主要是薄的原位黑色素瘤，这引起了对过度诊断的关注。
