Dempsey Kathy, Costa Daniel Sj, Brennan Meagan E, Mann G Bruce, Snook Kylie L, Spillane Andrew J
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Breast & Surgical Oncology at The Poche Centre, North Sydney, New South Wales, Australia.
BMJ Oncol. 2023 Dec 21;2(1):e000100. doi: 10.1136/bmjonc-2023-000100. eCollection 2023.
Non-mortality benefits of breast cancer screening are rarely considered in assessments of benefits versus harms. This study aims to estimate the rate of overdiagnosis in women with screen-detected breast cancer (SDBC) by allocating cases to either possibly overdiagnosed (POD) or not overdiagnosed categories and to compare treatment recommendations for surgery and adjuvant treatments by category, age at diagnosis and cancer stage.
Retrospective secondary analysis of 10 191 women diagnosed with breast cancer in Australia and New Zealand in 2018. Treatment recommendations for 5226 women with SDBC and 4965 women with non-SDBC (NSDBC) were collated and analysed. Descriptive statistics were used to calculate proportions and risk ratios (RRs).
The POD rate was 15.8%. Screening detected 66.3% of stage 0 tumours, 59% of stage 1, 40% of stage 2 and 27.5% of stage 3 tumours. Women with SDBC were less likely than their NSDBC counterparts to receive chemotherapy (RR 0.60 Aus/0.53 NZ), immunotherapy (mostly human epidermal growth factor 2 receptor therapy) (RR 0.58 Aus/0.82 NZ), mastectomy (RR 0.55 Aus/0.63 NZ) and axillary lymph node dissection (RR 0.49 Aus/0.52 NZ), or to require both mastectomy and radiotherapy (RR 0.41 Aus/0.34 NZ). Less than 1% of POD women were recommended chemotherapy, 9.5% radiotherapy, 6.4% endocrine therapy, 2.2% mastectomy and 0.5% axillary lymph node dissection.
Women with SDBCs required less intensive treatment; rates of possible overtreatment of SDBCs are relatively low and may be minimised through multidisciplinary discussion and shared decision-making. Reduced treatment intensity should be considered when balancing the potential benefits and harms of screening.
在评估乳腺癌筛查的利弊时，很少考虑其非死亡益处。本研究旨在通过将筛查发现的乳腺癌（SDBC）病例分为可能过度诊断（POD）或未过度诊断类别，来估计SDBC女性的过度诊断率，并比较按类别、诊断年龄和癌症分期的手术及辅助治疗建议。
对2018年在澳大利亚和新西兰诊断为乳腺癌的10191名女性进行回顾性二次分析。整理并分析了5226名SDBC女性和4965名非SDBC（NSDBC）女性的治疗建议。采用描述性统计来计算比例和风险比（RRs）。
POD率为15.8%。筛查发现0期肿瘤的66.3%、1期的59%、2期的40%和3期的27.5%。与NSDBC女性相比，SDBC女性接受化疗（RR澳大利亚0.60/新西兰0.53）、免疫治疗（主要是人表皮生长因子2受体治疗）（RR澳大利亚0.58/新西兰0.82）、乳房切除术（RR澳大利亚0.55/新西兰0.63）和腋窝淋巴结清扫术（RR澳大利亚0.49/新西兰0.52），或同时需要乳房切除术和放疗（RR澳大利亚0.41/新西兰0.34）的可能性较小。不到1%的POD女性被建议进行化疗，9.5%进行放疗，6.4%进行内分泌治疗，2.2%进行乳房切除术，0.5%进行腋窝淋巴结清扫术。
SDBC女性所需的治疗强度较低；SDBC可能过度治疗的发生率相对较低，可通过多学科讨论和共同决策将其降至最低。在权衡筛查的潜在利弊时，应考虑降低治疗强度。
