Prediagnosticiranje Overdiagnosis

Povzetek

V tem prispevku bomo opisali pojav pri raku, ki ga po angleško imenujemo overdiagnosis. Za izraz še ni uradno sprejetega slovenskega prevoda, v tem prispevku pa bomo uporabili izraz prediagnosticiranje, ki označuje raka, ki ne bi povzročil simptomov ali smrti, če ne bi bil diagnosticiran. Za to sta potrebna 2 pogoja: obstoj večje baze subkliničnega raka in aktivno odkrivanje te baze, presejanje. Ocena prediagnosticiranja pri presejanju je znana iz randomiziranih študij: 25 % za raka dojk, 50 % za pljučnega raka in več kot 60 % za raka prostate. Retrospektivne študije in populacijska statistika kažejo na prediagnosticiranje pri nevroblastomu, ščitničnem raku, raku ledvic in melanomu. Zato je treba bolnike seznaniti z velikostjo problema in možnostmi negativnih učinkov zdravljenja bolezni, ki jih morda ne bi nikoli prizadela. Pogostost prediagnosticiranja bi bilo treba bolje oceniti in odkriti metode, s katerimi bi ta problem zmanjšali.

Abstract (Eng)

In this article we will describe a phenomenon in cancer medicine known as overdiagnosis. As there is still no official Slovenian translation for this term, a Slovenian term “prediagnosticiranje” is used in the article, specifying cancer that does not cause symptoms or death if undiagnosed. This requires two conditions: an existence of a larger sub-clinical cancer base and active detection of this base, screening. Randomised studies have provided estimates of overdiagnosis in screening, being: 25% for breast cancer, 50% for lung cancer, and more than 60% for prostate cancer. Restrospective studies and population statistics show overdiagnosis of neuroblastoma, thyroid cancer, kidney cancer and melanoma. Therefore, the patients must be informed of the size of the problem and the possible negative effects of treatment of this disease, which might otherwise never have affected them at all. Thus, it would be necessary to provide better estimates of overdiagnosis frequency and discover the methods to minimise this problem.