ArticleBreast cancer research : BCR2013
Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time.
Article in Breast cancer research : BCR, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
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31 citing papers in PubMed, 2 syntheses or guidelines pooled it.
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- Advancing women's health in Egypt: an economic evaluation of the presidential initiative for nationwide breast cancer early detection and treatment.Archives of public health = Archives belges de sante publique · 2026Article
- Survival Benefits and Less Intensive Treatment for Women with Early-Stage Breast Cancer Diagnosed While Participating in Population-Based Screening.Annals of surgical oncology · 2025Article
- Quantifying Overdiagnosis for Multicancer Detection Tests: A Novel Method.Statistics in medicine · 2024Article
- Article
- Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort.Annals of internal medicine · 2022Article
- Tumor-associated lymphocytes and macrophages are related to stromal elastosis and vascular invasion in breast cancer.The journal of pathology. Clinical research · 2021Article
- Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Article
- Number of prior negative screening outcomes does not influence future risk of breast cancer.European journal of epidemiology · 2020Article
- Article
- Identification of the Fraction of Indolent Tumors and Associated Overdiagnosis in Breast Cancer Screening Trials.American journal of epidemiology · 2019Article
- Editorial: Challenges in Quantifying Overdiagnosis.Journal of the National Cancer Institute · 2017Article
- Trends in Breast Cancer Epidemiology in Chelyabinsk Region, 2006-2015Asian Pacific journal of cancer prevention : APJCP · 2017Article
- Evaluation issues in the Swedish Two-County Trial of breast cancer screening: An historical review.Journal of medical screening · 2017Article
- Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study.British journal of cancer · 2017Article
- Estimation of overdiagnosis using short-term trends and lead time estimates uncontaminated by overdiagnosed cases: Results from the Norwegian Breast Screening Programme.Journal of medical screening · 2016Article
- Radiation risk of breast screening in England with digital mammography.The British journal of radiology · 2016Article
- Conditions for Valid Empirical Estimates of Cancer Overdiagnosis in Randomized Trials and Population Studies.American journal of epidemiology · 2016Article
- Recognizing the Limitations of Cancer Overdiagnosis Studies: A First Step Towards Overcoming Them.Journal of the National Cancer Institute · 2016Review
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Abstract
backgroundOverdiagnosis in breast cancer screening is a controversial topic. One difficulty in estimation of overdiagnosis is the separation of overdiagnosis from lead time that is the advance in the time of diagnosis of cancers, which confers an artificial increase in incidence when a screening programme is introduced.
methodsWe postulated a female population aged 50-79 with a similar age structure and age-specific breast cancer incidence as in England and Wales before the screening programme. We then imposed a two-yearly screening programme; screening women aged 50-69, to run for twenty years, with exponentially distributed lead time with an average of 40 months in screen-detected cancers. We imposed no effect of the screening on incidence other than lead time.
resultsComparison of age- and time-specific incidence between the screened and unscreened populations showed a major effect of lead time, which could only be adjusted for by follow-up for more than two decades and including ten years after the last screen. From lead time alone, twenty-year observation at ages 50-69 would confer an observed excess incidence of 37%. The excess would only fall below 10% with 25 years or more follow-up. For the excess to be nullified, we would require 30 year follow-up including observation up to 10 years above the upper age limit for screening.
conclusionStudies using shorter observation periods will overestimate overdiagnosis by inclusion of cancers diagnosed early due to lead time among the nominally overdiagnosed tumours.
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