JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Innovent Biologics, Shanghai 200050, China.
Curr Oncol. 2024 Sep 20;31(9):5643-5651. doi: 10.3390/curroncol31090418.
The incidence of prostate, breast, and thyroid cancers has increased in China over the past few decades. Whether and how much these increases can be attributed to overdiagnosis are less understood. This study aimed to estimate the proportion of overdiagnosis among these three cancers in China during 2004-2019. The age-specific cancer incidence, cancer mortality, and all-cause mortality in China were extracted from the Global Burden of Diseases 2019. The lifetime risk of developing and that of dying from each cancer were calculated using the life table method. The proportion of overdiagnosis of a cancer was estimated as the difference between the lifetime risk of developing the cancer and that of suffering from the cancer (including death, metastasis, and symptoms caused by the cancer), further divided by the lifetime risk of developing the cancer. The highest possible values of these parameters were adopted in the estimation so as to obtain the lower bounds of the proportions of overdiagnosis. Sensitivity analyses assuming different lag periods between the diagnosis of a cancer and death from the cancer were performed. The results showed that the lifetime risk of developing prostate, breast, and thyroid cancer increased dramatically from 2004 to 2019 in China, while the increase in the lifetime risk of dying from these cancers was less pronounced. The proportions of overdiagnosis among prostate, breast, and thyroid cancers were estimated to be 7.88%, 18.99%, and 24.92%, respectively, in 2004, and increased to 18.20%, 26.25%, and 29.24%, respectively, in 2019. The increasing trends were statistically significant for all three cancers (all < 0.001). In sensitivity analyses, the proportions of overdiagnosis decreased, but upward trends over time remained for all three cancers. In conclusion, the overdiagnosis of prostate, breast, and thyroid cancers in China increased from 2004 to 2019, with the highest proportion seen in thyroid cancer and the most rapid increase seen in prostate cancer. Multifaceted efforts by policy makers, guideline developers, and clinicians are needed to tackle this problem.
在过去的几十年里，中国前列腺癌、乳腺癌和甲状腺癌的发病率有所上升。这些增长有多少可以归因于过度诊断尚不清楚。本研究旨在估计 2004-2019 年期间中国这三种癌症的过度诊断比例。从 2019 年全球疾病负担中提取了中国特定年龄的癌症发病率、癌症死亡率和全因死亡率。使用生命表法计算了每种癌症的发病终身风险和死于癌症的终身风险。癌症过度诊断的比例被估计为癌症发病终身风险与癌症发病后（包括死亡、转移和癌症引起的症状）风险之间的差异，进一步除以癌症发病终身风险。在估计中采用了这些参数的最高可能值，以便获得过度诊断比例的下限。还进行了假设癌症诊断与死于癌症之间存在不同滞后期的敏感性分析。结果表明，中国前列腺癌、乳腺癌和甲状腺癌的发病终身风险从 2004 年到 2019 年急剧上升，而死于这些癌症的终身风险增加则不那么明显。2004 年，前列腺癌、乳腺癌和甲状腺癌的过度诊断比例分别估计为 7.88%、18.99%和 24.92%，2019 年分别上升至 18.20%、26.25%和 29.24%。所有三种癌症的上升趋势均具有统计学意义（均<0.001）。在敏感性分析中，过度诊断的比例有所下降，但所有三种癌症的时间趋势仍呈上升趋势。总之，2004 年至 2019 年期间，中国前列腺癌、乳腺癌和甲状腺癌的过度诊断比例有所增加，其中甲状腺癌的比例最高，前列腺癌的增长速度最快。政策制定者、指南制定者和临床医生需要多方面努力来解决这个问题。
