Helvie Mark A
Michigan Medicine - University of Michigan, Department of Radiology, Ann Arbor, MI.
J Breast Imaging. 2019 Dec 5;1(4):278-282. doi: 10.1093/jbi/wbz059.
Overdiagnosis of breast cancer refers to the screen detection and diagnosis of breast cancer that would not have progressed to symptomatic cancer during a woman's lifetime. Screening mammography, like all screening tests, will result in some overdiagnosis that is attributable to competing causes of death occurring during the lead time (the time period between asymptomatic screen detection and clinical detection) and detection of very indolent cancer. The primary harm of overdiagnosis relates to subsequent (unnecessary) treatment. Importantly, overdiagnosis concerns must be balanced with the lifesaving and morbidity benefits of screening mammography and the prevention of some invasive cancer by detection and treatment of ductal carcinoma in situ. Reasonable estimates of overdiagnosis of women aged 40-80 years are in the order of 1%-10%, with lower values when overdiagnosis is restricted to invasive cancer and among younger women. Prospective identification of an overdiagnosed invasive cancer is not currently possible. Delaying screening until age 50 years or screening biennially rather than annually will not substantially reduce the amount of overdiagnosis of invasive cancer. The clinical significance of overdiagnosis will continue to be minimized as advances in personalized medicine further reduce treatment-associated morbidity.
乳腺癌的过度诊断是指对那些在女性一生中不会发展为有症状癌症的乳腺癌进行筛查检测和诊断。与所有筛查测试一样，乳腺钼靶筛查会导致一些过度诊断，这归因于在领先时间（无症状筛查检测与临床检测之间的时间段）发生的其他死因以及检测到的生长非常缓慢的癌症。过度诊断的主要危害与随后（不必要的）治疗有关。重要的是，对过度诊断的担忧必须与乳腺钼靶筛查的救命和降低发病率的益处以及通过原位导管癌的检测和治疗预防一些浸润性癌症相权衡。40 - 80岁女性过度诊断的合理估计约为1% - 10%，当过度诊断仅限于浸润性癌症且在年轻女性中时，数值会更低。目前尚无法前瞻性地识别出过度诊断的浸润性癌症。将筛查推迟到50岁或改为每两年而不是每年进行一次筛查，并不会大幅减少浸润性癌症的过度诊断量。随着个性化医疗的进展进一步降低与治疗相关的发病率，过度诊断的临床意义将继续被最小化。
