title: Influence of study features and methods on overdiagnosis estimates in breast and prostate cancer screening.
abstract: 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.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. retzioni@fhcrc.org
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.forename: Roman
authors.initials: R
authors.lastname: Gulati
authors.forename: Leslie
authors.initials: L
authors.lastname: Mallinger
authors.forename: Jeanne
authors.initials: J
authors.lastname: Mandelblatt
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D015233:Models, Statistical; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012107:Research Design