Role of overdiagnosis in the rising incidence of endometrial cancer: a population-based ecological study.

IF 7.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

BMJ Evidence-Based Medicine Pub Date : 2025-07-24 DOI:10.1136/bmjebm-2025-113688

Behrad Barmayehvar, Alireza Behzadnia, Brian Nicholson, Per-Henrik Zahl, Jason Oke

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引用次数: 0

Abstract

Objectives: Endometrial cancer (EC) incidence has been rising globally, while mortality has remained stable, particularly in Nordic countries. This study aimed to explore the role of transvaginal ultrasound (TVUS) use and overdiagnosis in these trends.

Methods: We analysed crude and age-adjusted EC incidence and mortality rates by stage and age group using data from the Norwegian Cancer and Causes of Death Registries (1970-2019). Annual percentage changes (APC) in early-stage and late-stage cancers were estimated using linear regression. Trends were assessed with the Mann-Kendall test and Theil-Sen estimator. Spearman's correlation evaluated the relationship between regional TVUS billing rates and EC incidence.

Results: From 1970 to 2019, age-standardised EC incidence in Norway increased by 79% (16.7-30.0 per 100 000), with a five-yearly growth rate of 7.47% (p=0.020). Mortality remained stable until 2000-2004, with a non-significant drop from 5.0 to 2.75 per 100 000 by 2019 (Sen's slope: -0.20, p=0.15). In postmenopausal women, early-stage incidence rose by 73% (32.1-55.5 per 100 000) and late-stage diagnoses increased by 108% (7.0-14.6 per 100 000). In premenopausal women, early-stage incidence declined by 24% (3.3-2.5 per 100 000), while late-stage diagnoses rose by 189% (0.23-0.66 per 100 000). TVUS use rose from 7.6% to 8.3% annually (2006-2019). The APC in postmenopausal women was similar across stages, with the largest increase in those aged 70+ years. Evidence for TVUS driving early-stage diagnoses was not strong, although a weak correlation between the two was observed in postmenopausal women (r=0.35, p<0.05).

Conclusions: Overdiagnosis and stage migration may explain the rising EC incidence in postmenopausal women. In premenopausal women, overdiagnosis is less likely. TVUS is unlikely to be the main driver of the trends. Further research is needed to clarify the interplay of factors affecting EC trends globally.

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过度诊断在子宫内膜癌发病率上升中的作用：一项基于人群的生态学研究。

目的：全球子宫内膜癌（EC）发病率一直在上升，而死亡率保持稳定，特别是在北欧国家。本研究旨在探讨经阴道超声（TVUS）的使用和过度诊断在这些趋势中的作用。方法：我们使用挪威癌症和死亡原因登记处（1970-2019）的数据，按阶段和年龄组分析了粗糙的和年龄调整的EC发病率和死亡率。使用线性回归估计早期和晚期癌症的年百分比变化（APC）。使用Mann-Kendall检验和Theil-Sen估计器评估趋势。Spearman的相关性评估了区域TVUS计费费率与EC发病率之间的关系。结果：1970 - 2019年，挪威年龄标准化EC发病率增加了79%（16.7-30.0 / 10万），5年增长率为7.47% （p=0.020）。到2000-2004年，死亡率保持稳定，到2019年，死亡率从每10万人5.0人下降到2.75人（森斜率：-0.20,p=0.15）。在绝经后妇女中，早期诊断增加了73%（32.1-55.5 / 10万），晚期诊断增加了108%（7.0-14.6 / 10万）。在绝经前妇女中，早期发病率下降了24%（每10万人3.3-2.5例），而晚期诊断上升了189%（每10万人0.23-0.66例）。电视单元的使用率从每年7.6%上升到8.3%（2006-2019年）。绝经后妇女的APC在各个阶段相似，70岁以上妇女的APC增幅最大。尽管在绝经后妇女中观察到两者之间的弱相关性（r=0.35），但TVUS驱动早期诊断的证据并不强。结论：过度诊断和分期迁移可能解释了绝经后妇女EC发病率上升的原因。在绝经前妇女中，过度诊断的可能性较小。TVUS不太可能成为这一趋势的主要推动力。需要进一步的研究来阐明影响全球气候变化趋势的因素之间的相互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Evidence-Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

8.90

自引率

3.40%

发文量

期刊介绍： BMJ Evidence-Based Medicine (BMJ EBM) publishes original evidence-based research, insights and opinions on what matters for health care. We focus on the tools, methods, and concepts that are basic and central to practising evidence-based medicine and deliver relevant, trustworthy and impactful evidence. BMJ EBM is a Plan S compliant Transformative Journal and adheres to the highest possible industry standards for editorial policies and publication ethics.