title: Life expectancy estimates as a key factor in over-treatment: the case of prostate cancer.
abstract: OBJECTIVE
  To estimate the magnitude of over-diagnosis and of potential and actual over-treatment regarding prostate cancer, taking comorbidities into account.
  
  
  METHODS
  We used a sample collected by the French cancer registries of 1840 cases (T1: 583; T2: 1257) diagnosed in 2001. The proportion of over-diagnosed and over-treated patients was estimated by comparing life expectancy (LE), including or not comorbidities, with natural LE with cancer, using several assumptions from the literature. We distinguished potential and actual over-treatment according to the treatment that patients actually received.
  
  
  RESULTS
  Among patients with T1 tumors the proportion of potential over-treatment using LE adjusted for comorbidity varied from 29.5% to 53.5%, using LE adjusted on comorbidities, and varied from 9.3% to 22.2% regarding actual over-treatment. Between 7.7% and 24.4% of patient's receiving a radical prostatectomy, and between 30.8% and 62.5% of those receiving radiotherapy, were over-treated. Among patients with T2 tumors, the proportions of potential and actual over-treatment were 0.9% and 2.0%. Two per cent of patients receiving a radical prostatectomy and 4.9% of those receiving radiotherapy were over-treated. Comorbidities dramatically increased these proportions to nearly 100% of patients, with more than two comorbidities being potentially over-treated and around 33% actually over-treated.
  
  
  CONCLUSIONS
  According to the French incidence, 3200-4800 French patients may be over-treated, among whom a large proportion of patients had comorbidities. The real issue is to offer the most appropriate treatment to people with low-grade tumors and comorbidities.
authors.affiliation: Inserm, UMR1027, Toulouse F-31062, France. cyrille.delpierre@inserm.fr
authors.forename: Cyrille
authors.initials: C
authors.lastname: Delpierre
authors.forename: Sébastien
authors.initials: S
authors.lastname: Lamy
authors.forename: Michelle
authors.initials: M
authors.lastname: Kelly-Irving
authors.forename: Florence
authors.initials: F
authors.lastname: Molinié
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
authors.forename: Brigitte
authors.initials: B
authors.lastname: Tretarre
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Woronoff
authors.forename: Antoine
authors.initials: A
authors.lastname: Buemi
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Lapôtre-Ledoux
authors.forename: Simona
authors.initials: S
authors.lastname: Bara
authors.forename: Anne-Valérie
authors.initials: AV
authors.lastname: Guizard
authors.forename: Marc
authors.initials: M
authors.lastname: Colonna
authors.forename: Pascale
authors.initials: P
authors.lastname: Grosclaude
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D012042:Registries; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*