title: Missteps in Current Estimates of Cancer Overdiagnosis.
abstract: The balance between the benefits and harms of imaging-based cancer screening continues to be an area of controversy and widespread media attention. Of the potential harms, overdiagnosis from screening is likely the most elusive in estimating and quantifying. This article describes the major methodological issues with recently reported estimates of overdiagnosis that are based on excess cancer incidence, and suggests that modeling focused on tumor lead-time can serve as a complementary method for excess incidence-based overdiagnosis estimates. Radiologists should be conversant on the topic of overdiagnosis and understand the limitations of different methods used to estimate its magnitude.
authors.affiliation: Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, G3-200, Seattle, WA 98109-1023; Department of Health Services, University of Washington School of Public Health, Seattle, Washington. Electronic address: stophlee@uw.edu.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000379:methods; D008403:Mass Screening / Q000379:methods; D000069342:Medical Overuse; D008875:Middle Aged; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic
keywords: Overdiagnosis; cancer screening; mammography; overtreatment