title: A reality check for overdiagnosis estimates associated with breast cancer screening.
abstract: The frequency of overdiagnosis associated with breast cancer screening is a topic of controversy. Published estimates vary widely, but identifying which estimates are reliable is challenging. In this article we present an approach that provides a check on these estimates. Our approach leverages the close link between overdiagnosis and lead time by identifying the average lead time most consistent with a given overdiagnosis frequency. We consider a high-profile study that suggested that 31% of breast cancers diagnosed in the United States in 2008 were overdiagnosed and show that this corresponds to an average lead time of about nine years among localized cases. Comparing this estimate with the average lead time for invasive, screen-detected breast cancers of 40 months, around which there is a relative consensus, suggests the published estimate of overdiagnosis is excessive. This approach provides a novel way to appraise estimates of overdiagnosis given knowledge of disease natural history.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (RE, JX, NSW, RG); Group Health Research Institute, Seattle WA (RH); Department of Epidemiology, University of Washington, Seattle WA (NSW). retzioni@fhcrc.org.
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (RE, JX, NSW, RG); Group Health Research Institute, Seattle WA (RH); Department of Epidemiology, University of Washington, Seattle WA (NSW).
authors.forename: Jing
authors.initials: J
authors.lastname: Xia
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (RE, JX, NSW, RG); Group Health Research Institute, Seattle WA (RH); Department of Epidemiology, University of Washington, Seattle WA (NSW).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hubbard
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (RE, JX, NSW, RG); Group Health Research Institute, Seattle WA (RH); Department of Epidemiology, University of Washington, Seattle WA (NSW).
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (RE, JX, NSW, RG); Group Health Research Institute, Seattle WA (RH); Department of Epidemiology, University of Washington, Seattle WA (NSW).
authors.forename: Roman
authors.initials: R
authors.lastname: Gulati
mesh_terms: D000328:Adult; D000368:Aged; D015982:Bias; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D013997:Time Factors; D014481:United States / Q000453:epidemiology