肿瘤过度诊断的现状、原因及对策

Over-diagnosis of Tumor-related Disease:status quo,causes and countermeasures

肿瘤及其相关疾病的"过度诊断"是一个近些年被国内外业内人士热议的话题。本文基于文献检索和分析,对肿瘤过度诊断的现状进行了阐述,包括:医学界对其关注度的变化、过度诊断的主要病种分布(乳腺癌、前列腺癌、甲状腺癌、子宫癌、肺癌等)、过度诊断发生的原因("先进"的诊断技术、商业化的体检、积极的医生和特有的中国元素)及其造成的危害(患者额外的医源性病痛、卫生资源的浪费、使社会欠公平、对卫生状况的误解)等,筛检方法、筛检对象、医生对过度诊断的认识度也与之相关。问题的关键在于寻找更好的评估过度诊断的方法和临床策略促使其最小化,患者也应成为明智的筛查实验的参与者,并对筛查的阳性结果与临床医生共同做出进一步的理智选择。

Over-diagnosis in tumor-related diseases is an emerging problem in recent years.To describe the phenomenon and figure out the reason of over-diagnosis by review the comprehensive searched literature from the Databases of PubMed（English）and Weipu（Chinese）and Wanfang（Chinese）,the authors summarized the detail about over-diagnosis including the trend of focus,the disease distribution（breast cancer,prostate cancer,thyroid cancer,ovarian cancer,lung cancer,et al）,the causes of occurrence（advances in diagnostic techniques,commercial screening,active doctor,specific Chinese elements）and the harm to the society and person＇s health（suffering side effect,waste resource,distributive justice,misconception about health status）.Over-diagnosis is related to many things such as the method of screening,the patients,the degree of Doctor knew about it else.It is critical and essential for researchers to develop better estimate of the magnitude of over diagnosis and develop clinical strategies to help minimize it.It is necessary for patients to become wise consumers of screening tests and make decisions with their physicians regarding further testing and treatment.