癌症筛查中过度诊断的评测方法

Methods for Quantifying Overdiagnosis in Cancer Screening

过度诊断是评价癌症筛查利弊的关键问题,但对其准确评测存在一定难度,国内相关研究也十分有限。全文对评测过度诊断情况的指标进行了定义,全面介绍了国际上用于癌症筛查过度诊断情况评测的三类主要方法,结合相关研究设计总结了六种设置未筛查对照的方法,对比分析了各种方法的数据要求、应用条件、优势及缺点,提供了经典案例和应用建议,以期为正确评测筛查中的过度诊断情况提供方法思路。

Overdiagnosis is a key issue in evaluating the benefits and harms of cancer screening.However,there is a lack of studies on overdiagnosis in cancer screening from China,as it is difficult to quantify the overdiagnosis accurately.This article gives the definition of metric for measuring overdiagnosis in cancer screening;comprehensively introduces three major approaches used to quantify overdiagnosis internationally;and presents six methods to set unscreened control population according to study design.Data requirements,application conditions,strengths and limitations of above methods are compared and analyzed.The article also provides some reference cases and suggestions to guide the good practices for choosing appropriate methods to obtain the unbiased estimates of overdiagnosis from cancer screening.