用终身风险方法估计美国黑色素瘤过度诊断的生态研究
Adewole S Adamson1, Geetanjali Naik2, Mark A Jones3
1Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas, USA adewole.adamson@austin.utexas.edu.
BMJ evidence-based medicine
|January 19, 2024
概括
黑色素瘤的过度诊断在美国是一个重大问题,近一半的男性黑色素瘤诊断和超过一半的女性可能被过度诊断. 这种趋势正在增加,特别是在现场黑色素瘤.
科学领域:
- 皮肤病学 皮肤病学
- 在瘤学瘤学.
- 流行病学 流行病学
背景情况:
- 在美国,黑色素瘤的发病率一直在上升.
- 了解过度诊断的程度对于有效的公共卫生战略和资源配置至关重要.
- 以前对黑色素瘤过度诊断的估计有所不同,需要更新量化.
研究的目的:
- 量化美国可能被过度诊断的黑色素瘤诊断 (侵入性和现场诊断) 的比例.
- 从1975年到2018年,分析美国白人男性和女性黑色素瘤过度诊断的趋势.
主要方法:
- 使用监测,流行病学和最终结果 (SEER 9) 注册表数据进行的生态研究.
- DevCan软件用于计算黑色素瘤诊断的累积终身风险,并根据寿命和风险因素变化进行调整.
- 分析的重点是1975-2018年美国白人男性和女性,过度诊断的原因是过度的终身风险.
主要成果:
- 对黑色素瘤诊断的调整终身风险在1975-2018年间在白人男性和女性中显著增加.
- 在现场诊断黑色素瘤的数量急剧上升,男性从0.17%增加到2.7%,女性从0.08%增加到2.0%.
- 2018年,估计白人男性49.7%的黑色素瘤和白人女性64.6%的黑色素瘤被过度诊断;85-89%的现场黑色素瘤可能被过度诊断.
结论:
- 白人美国人的黑色素瘤过度诊断是相当大的,并且随着时间的推移而增加.
- 2018年,估计有44,000名男性和39,000名女性被过度诊断为黑色素瘤.
- 过度诊断的高比例的黑色素瘤是在现场发生的,这表明这种亚型是干预的关键领域.
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