Ruth Etzioni, PhD; Roman Gulati, MS; Leslie Mallinger, MPH; Jeanne Mandelblatt, MD, MPH
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or the Centers for Disease Control and Prevention.
Financial Support: By award numbers U01CA157224 and U01CA088283 and U01CA152958 from the National Cancer Institute and the Centers for Disease Control and Prevention. Additional funding was provided by award numbers KO5CA96940 and P01CA154292.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3000.
Requests for Single Reprints: Ruth Etzioni, PhD, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024; e-mail, email@example.com.
Current Author Addresses: Dr. Etzioni, Mr. Gulati, and Ms. Mallinger: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024.
Dr. Mandelblatt: Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street Northwest, Suite 4100, Washington, DC 20007.
Author Contributions: Conception and design: R. Etzioni, R. Gulati, J. Mandelblatt.
Analysis and interpretation of the data: R. Etzioni, R. Gulati, L. Mallinger.
Drafting of the article: R. Etzioni, R. Gulati, J. Mandelblatt.
Critical revision of the article for important intellectual content: R. Etzioni, R. Gulati, L. Mallinger, J. Mandelblatt.
Final approval of the article: R. Etzioni, R. Gulati, L. Mallinger, J. Mandelblatt.
Statistical expertise: R. Etzioni, R. Gulati.
Obtaining of funding: R. Etzioni, R. Gulati.
Administrative, technical, or logistic support: R. Gulati.
Collection and assembly of data: R. Gulati, L. Mallinger.
Knowledge of the likelihood that a screening-detected case of cancer has been overdiagnosed is vitally important to make treatment decisions and develop screening policy. An overdiagnosed case is an excess case detected by screening. Estimates of the frequency of overdiagnosis in breast and prostate cancer screening vary greatly across studies. This article identifies features of overdiagnosis studies that influence results and shows their effect by using published research. First, different ways to define and measure overdiagnosis are considered. Second, contextual features and how they affect overdiagnosis estimates are examined. Third, the effect of estimation approach is discussed. Many studies use excess incidence under screening as a proxy for overdiagnosis. Others use statistical models to make inferences about lead time or natural history and then derive the corresponding fraction of cases that are overdiagnosed. This article concludes with questions that readers of overdiagnosis studies can use to evaluate the validity and relevance of published estimates and recommends that authors of studies quantifying overdiagnosis provide information about these features.
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Etzioni R, Gulati R, Mallinger L, Mandelblatt J. Influence of Study Features and Methods on Overdiagnosis Estimates in Breast and Prostate Cancer Screening. Ann Intern Med. 2013;158:831-838. doi: 10.7326/0003-4819-158-11-201306040-00008
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Published: Ann Intern Med. 2013;158(11):831-838.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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