{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282679441763584.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.3804/jjabcs.23.337"}},{"identifier":{"@type":"URI","@value":"https://www.jstage.jst.go.jp/article/jjabcs/23/3/23_337/_pdf"}},{"identifier":{"@type":"NAID","@value":"130005431637"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2015029060"}}],"dc:title":[{"@language":"ja","@value":"乳癌検診の過剰診断について"},{"@language":"en","@value":"Measures for Reducing Over-diagnosis in Breast Cancer Screening"}],"dcterms:alternative":[{"@language":"ja","@value":"―避けるための対応策―"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"en","@value":"The US Preventive Services Task Force (USPSTF) assesses the efficacy of breast cancer screening by the sum of its benefits and harms. Randomized clinical trials (RCTs) of breast cancer screening in Europe and the US have shown 15～32% mortality reduction in the 40～69-year age group. As well as reduction of over-diagnosis, quality control of screening is important for reducing the rates of false positivity, false negativity, and recall. Over-diagnosis in cancer screening has become a hot topic in Europe and the US. 'Over-diagnosis' means the detection and diagnosis of cancers that do not affect the life of the patient. Over-diagnosis is most common during screening for neuroblastoma, prostate cancer, lung cancer and thyroid cancer. Data from Europe and the US indicate that about 10～30% of breast cancers are over-diagnosed by screening. Even in early-stage breast cancer, some lesions, such as non-invasive cancers, can be over-diagnosed. The mammography screening rate in Japan is as low as 20～30%, compared with 70～80% in Europe and the US. In Japan, in addition to emphasizing the harm of screening, it is necessary to improve the participation rate in quality-controlled mammography screening (to 50% or more). In particular, population-based screening should conform to guidelines that are evidence-based for mortality reduction. We also need to perform clinicopathological studies of breast cancers that may be over-diagnosed, and compile data on over-diagnosis. For prevention of over-diagnosis, we need to avoid excessive detailed examinations and over-treatment, and should also consider establishing observation (watchful waiting) groups. There is also a need for joint decision-making between examinees and medical institutions regarding the harm of screening. Treatment of breast cancers that are suspected to be over-diagnosed should be undertaken on the basis of an informed decision by the examinee."},{"@language":"ja","@value":"2009年の米国予防医学専門委員会(USPSTF)の勧告では，乳癌検診の評価は，利益(死亡率減少効果)のみでなく，不利益(偽陽性，偽陰性，過剰診断，被曝，精神的影響等)も考慮する必要があり，検診の利益と不利益のバランスを考慮すべきであるとされている。欧米の乳癌検診における無作為比較試験(RCT)の結果から，死亡率減少効果は40～69歳の年齢層で15～32%ある。不利益のうち，過剰診断以外の偽陽性，偽陰性，要精検率等を如何に抑えるか，つまり検診の精度管理が重要である。一方，癌検診の不利益のうちの過剰診断が欧米で話題になっているが，過剰診断とは，その人の寿命に影響を及ぼさない癌を発見・診断することである。各種の癌検診における過剰診断は，神経芽細胞腫，前立腺癌，胸部CT で発見される肺癌，甲状腺癌などが知られている。多くの欧米データから，検診発見乳癌の10～30%程度に過剰診断があるとされる。早期乳癌なかでも非浸潤癌等の一部の病変は，過剰診断に繋がる可能性が大きく，また高齢者ではより過剰診断の可能性を考慮すべきである。本邦のマンモグラフィ検診は，欧米の受診率70～80%に比較して20～30%と低い。日本においては，不利益を理解した上で，死亡率減少効果という利益を求めて，精度管理のなされたマンモグラフィ検診受診率の向上(50%以上)に努めるべきである。とくに対策型検診では，死亡率減少効果のエビデンスに基づいたガイドラインに沿った検診を施行すべきである。さらに，過剰診断となり得る乳癌の臨床病理学的研究，日本における過剰診断のデータ蓄積が求められる。過剰診断に対しては，過剰な精密検査・過剰治療の回避のために，経過観察群watchful waiting の設定による対処も考えられる。また，受診者との不利益に関わる共同意思決定も必要であり，過剰診断と思われる乳癌の治療は，受診者とのinformed decisionの上で行うべきである。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410282679441763584","@type":"Researcher","foaf:name":[{"@language":"ja","@value":"森本 忠興"},{"@language":"en","@value":"Morimoto Tadaoki"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Professor Emeritus, The University of Tokushima"},{"@language":"ja","@value":"徳島大学名誉教授"}]},{"@id":"https://cir.nii.ac.jp/crid/1410282679441763586","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000345430232"}],"foaf:name":[{"@language":"ja","@value":"笠原 善郎"},{"@language":"en","@value":"Kasahara Yoshio"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Surgery, Fukui Saiseikai Hospital"},{"@language":"ja","@value":"福井県済生会病院乳腺外科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410282679441763585","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000345430234"}],"foaf:name":[{"@language":"ja","@value":"丹黒 章"},{"@language":"en","@value":"Tangoku Akira"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School"},{"@language":"ja","@value":"徳島大学大学院ヘルスバイオサイエンス研究部胸部・内分泌・腫瘍外科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410001204855096577","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258092213"}],"foaf:name":[{"@language":"ja","@value":"角田 博子"},{"@language":"en","@value":"Tsunoda Hiroko"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Radiology, St. Luke's International Hospital"},{"@language":"ja","@value":"聖路加国際病院放射線科"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"09180729"},{"@type":"EISSN","@value":"18826873"}],"prism:publicationName":[{"@language":"en","@value":"Nihon Nyugan Kenshin Gakkaishi (Journal of Japan Association of Breast Cancer Screening)"},{"@language":"ja","@value":"日本乳癌検診学会誌"},{"@language":"en","@value":"J.Jpn. Assoc.Breast Cancer Screen."},{"@language":"ja","@value":"日乳癌検診学会誌"},{"@language":"en","@value":"J. Jpn. Assoc. Breast Cancer Screen. Journal of Japan Association of Breast Cancer Screening"}],"dc:publisher":[{"@language":"en","@value":"Japan Association of Breast Cancer Screening"},{"@language":"ja","@value":"特定非営利活動法人　日本乳癌検診学会"}],"prism:publicationDate":"2014","prism:volume":"23","prism:number":"3","prism:startingPage":"337","prism:endingPage":"346"},"reviewed":"false","dcterms:accessRights":"http://purl.org/coar/access_right/c_abf2","url":[{"@id":"https://www.jstage.jst.go.jp/article/jjabcs/23/3/23_337/_pdf"},{"@id":"https://search.jamas.or.jp/link/ui/2015029060"}],"availableAt":"2014","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E4%B9%B3%E7%99%8C%E6%A4%9C%E8%A8%BA","dc:title":"乳癌検診"},{"@id":"https://cir.nii.ac.jp/all?q=%E9%81%8E%E5%89%B0%E8%A8%BA%E6%96%AD","dc:title":"過剰診断"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%88%A9%E7%9B%8A%E3%81%A8%E4%B8%8D%E5%88%A9%E7%9B%8A","dc:title":"利益と不利益"},{"@id":"https://cir.nii.ac.jp/all?q=breast%20cancer%20screening","dc:title":"breast cancer screening"},{"@id":"https://cir.nii.ac.jp/all?q=over-diagnosis","dc:title":"over-diagnosis"},{"@id":"https://cir.nii.ac.jp/all?q=benefit%20and%20harm","dc:title":"benefit and harm"}],"relatedProduct":[{"@id":"https://cir.nii.ac.jp/crid/1360292620666995328","@type":"Article","relationType":["references"],"jpcoar:relatedTitle":[{"@value":"Overdiagnosis in Mammographic Screening for Breast Cancer in Europe: A Literature Review"}]},{"@id":"https://cir.nii.ac.jp/crid/1360855569836363520","@type":"Article","relationType":["references"],"jpcoar:relatedTitle":[{"@value":"Branched-Chain Amino Acids"}]},{"@id":"https://cir.nii.ac.jp/crid/1361699995464277760","@type":"Article","relationType":["references"],"jpcoar:relatedTitle":[{"@value":"Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement"}]},{"@id":"https://cir.nii.ac.jp/crid/1361981468374206336","@type":"Article","relationType":["references"],"jpcoar:relatedTitle":[{"@value":"The benefits and harms of 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