Keywords
How to Cite
Abstract
Abstract
The article presents scientific evidence that confirms the new paradigm that “early” diagnosis is not always beneficial, and that screening and early diagnosis can do more harm than good. As a result, of screening, in a number of cases, lesions are diagnosed that, although have histological patterns of cancer, are often clinically insignificant, indolent i.e. overdiagnosis takes place. Such lesions primarily include latent cancers of the prostate and thyroid gland. An increase in the incidence of certain types of cancers in the United States and other developed countries, as a result, of the introduction of PSA screening, mammography, ultrasound examination of the neck and other highly sensitive diagnostic methods, with stable or decreasing mortality, is a sign of overdiagnosis. In Russia, there is also a marked increase in the incidence of cancer of the prostate, breast, thyroid, kidney and melanoma, while mortality from these forms of cancer is stable or decreasing. The increase in the incidence of all malignant formations in Russian, as in American men, is determined by the increase in the incidence of prostate cancer.
In randomized clinical trials of the efficacy of screening for prostate and breast cancer, an excess of the detected cases of cancer in the screening group compared with the control group indicates overdiagnosis. With an increase in follow-up (10-15 years), the number of excess cases in the screening group decreases. However, in some studies even after 10-15 years of follow-up, the excess of cancer cases in the screening group persisted, i.e. overdiagnosis was confirmed. Thus, the problem of overdiagnosis is also relevant to controlled clinical trials, despite a well-verified protocol and strict adherence to it. The danger of overdiagnosis in real life, daily practice, and especially with opportunistic screening, which, by definition, is carried out without quality control, is much higher. Overdiagnosis often leads to unnecessary, sometimes excessive treatment and a deterioration in the quality of life of patients who are not cancer patients.
Refusal of aggressive therapy and active follow-up should be the method of choice for the management of patients with asymptomatic neoplasms identified at the screening. Such tactics will avoid unnecessary and excessive interventions, which, in turn, will prevent a deterioration in the quality of life of patients and, in addition, will reduce the cost of treatment.
Key words: overdiagnosis, screening, early diagnosis, trends in incidence and mortality, prostate cancer, breast cancer, thyroid cancer
References
Заридзе Д.Г., Давыдов М.И. Скрининг злокачественных опухолей: современное состояние и перспективы. Вестник московского онкологического общества. 2014;3(606):2-6. [Zaridze D.G., Davydov M.I. Screening of malignant tumors: current status and prospects. Bulletin of the Moscow Cancer Society. 2014;3(606):2-6. (In Russ.)].
Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010 May 5;102(9):605-13. doi: 10.1093/jnci/djq099.
Заридзе Д. Г., Пропп Р. М. О маленьком раке щитовидной железы. Архив патологии. 1973; XXXV(12):24-27 [Zaridze D. G., Propp R. M. About a small thyroid cancer. Pathology Archive. 1973; XXXV(12):24-27 (In Russ.)].
Zaridze DG, Boyle P, Smans M. International trends in prostatic cancer. Int J Cancer. 1984 Feb 15;33(2):223-30.
Sakr WA, Wheeler TM, Blute M. et al. Staging and reporting of prostate cancer--sampling of the radical prostatectomy specimen. Cancer. 1996 Jul 15;78(2):366-8.
Stamatiou K, Alevizos A, Perimeni D. et al. Frequency of impalpable prostate adenocarcinoma and precancerous conditions in Greek male population: an autopsy study. Prostate Cancer Prostatic Dis. 2006;9(1):45-9.
Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study. Cancer. 1985 Aug 1;56(3):531-8.
Welch HG, Black WC. Using autopsy series to estimate the disease "reservoir" for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med. 1997 Dec 1;127(11):1023-8.
Zaridze D, Boyle P. Cancer of the prostate: epidemiology and aetiology. Br J Urol. 1987;59:493-503.
Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet. 2012 Nov 17;380(9855):1778-86.
Smith RA, Cokkinides V, Brawley O. Cancer screening in the United States, A review of current American Cancer Society guidelines and current issues in cancer screening. Ca Cancer J Clin. 2012;62:129-142. doi: 10.3322/caac.20143.
Zackrisson S, Andersson I, Janzon L. et al. Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ. 2006 Mar 25;332(7543):689-92.
Schröder FH, Hugosson J, Roobol MJ. et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009 Mar 26;360(13):1320-8. doi: 10.1056/NEJMoa0810084.
Schröder FH, Hugosson J, Roobol MJ. et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014 Dec 6;384(9959):2027-35. doi: 10.1016/S0140-6736(14)60525-0.
Auvinen A, Moss SM, Tammela TL. et al. Absolute Effect of Prostate Cancer Screening: Balance of Benefits and Harms by Center within the European Randomized Study of Prostate Cancer Screening. Clin Cancer Res. 2016 Jan 1;22(1):243-9. doi: 10.1158/1078-0432.CCR-15-0941.
Sone S, Takashima S, Li F. et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet. 1998 Apr 25;351(9111):1242-5.
Sone S, Li F, Yang ZG. et al. Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br J Cancer. 2001 Jan 5;84(1):25-32.
Treskova M, Aumann I, Golpon Y et al. Trade-off between benefits harms and efficiency of low-dose CT lung cancer screening: microsimulation analysis of nodule management strategies in a population-based setting. BMC Medicine, published online: August 2017, 25;15(1):162. doi: 10.1186/s12916-017-0924-3.
de Koning HJ, van der Aalst CM, de Jong PA. et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020 Feb 6;382(6):503-513. doi: 10.1056/NEJMoa1911793.
Vickers AJ, Sjoberg DD, Ulmert D. et al. Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen. BMC Med. 2014 Feb 11;12:26. doi: 10.1186/1741-7015-12-26.
Glasziou PP, Jones MA, Pathirana T. et al. Estimating the magnitude of cancer overdiagnosis in Australia. Med J Aust. 2020 Mar;212(4):163-168. doi: 10.5694/mja2.50455.
Roder DM, Buckley E. Overdiagnosis of cancer in Australia: the role of screening. Med J Aust. 2020 Mar;212(4):159-160. doi: 10.5694/mja2.50494.
La Vecchia C, Malvezzi M, Bosetti C. et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015 May 1;136(9):2187-95. doi: 10.1002/ijc.29251.
Carlberg M, Hedendahl L, Ahonen M, Koppel T, Hardell L. Increasing incidence of thyroid cancer in the Nordic countries with main focus on Swedish data. BMC Cancer. 2016;16:426. doi: 10.1186/s12885-016-2429-4.
Vaccarella S, Franceschi S, Bray F. Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med. 2016 Aug 18;375(7):614-7. doi: 10.1056/NEJMp1604412.
Ivanov VK, Kashcheev VV, Chekin SY. et al. Radiation-epidemiological studies of thyroid cancer incidence in Russia after the Chernobyl accident (estimation of radiation risks, 1991-2008 follow-up period). Radiat Prot Dosimetry. 2012 Sep;151(3):489-99. doi: 10.1093/rpd/ncs019.
Кащеев В.В., Чекин С.Ю., Максютов М.А. и др. Оценка радиационных рисков и эффекта скрининга рака щитовидной железы среди населения Брянской и Орловской областей российской Федерации. Радиация и риск. 2015; 24(1):1-16 [Kashcheev V.V., Chekin S. Yu., Maksyutov M.A. et al. Assessment of radiation risks and the effect of screening for thyroid cancer among the population of the Bryansk and Oryol regions of the Russian Federation. Radiation and risk. 2015;24(1):1-16.
Rosner D, Bedwani RN, Vana J. et al. Noninvasive breast carcinoma: results of a national survey by the American College of Surgeons. Ann Surg. 1980;192(2):139-147. doi: 10.1097/00000658-198008000-00001.
Ernster VL, Ballard-Barbash R, Barlow WE. et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002 Oct 16;94(20):1546-54.
Kuhl CK, Schrading S, Bieling HB. et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007 Aug 11;370(9586):485-92.
Esserman LJ, Thompson IM, Reid B. et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol. 2014 May;15(6):e234-42. doi: 10.1016/S1470-2045(13)70598-9.
Gardiner N, Jogai S, Wallis A. The revised lung adenocarcinoma classification-an imaging guide. J Thorac Dis. 2014;6(Suppl 5):S537–S546. doi: 10.3978/j.issn.2072-1439.2014.04.05.
Nikiforov YE, Seethala RR, Tallini G. et al. Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors. JAMA Oncol. 2016 Aug 1;2(8):1023-9. doi: 10.1001/jamaoncol.2016.0386.
Welch HG, Kramer BS, Black WC. Epidemiologic Signatures in Cancer. N Engl J Med. 2019 Oct 3;381(14):1378-1386. doi: 10.1056/NEJMsr1905447.
Заридзе Д.Г., Каприн А.Д., Стилиди И.С. Динамика заболеваемости и смертности от злокачественных новообразований в России. Вопросы онкологии. 2018;64(5):578-591 [Zaridze D.G., Kaprin A.D., Stilidi I.S. Dynamics of morbidity and mortality from malignant neoplasms in Russia. Vopr. Oncology. 2018;64(5):578-591 (In Russ.)].
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2020