ArticleBritish journal of cancer2013
Overestimated lead times in cancer screening has led to substantial underestimation of overdiagnosis.
Article in British journal of cancer, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods.BMJ (Clinical research ed.) · 2015Pooled it
- Estimating lead time and overdiagnosis in cancer screening programmes: the MOCCI method.International journal of epidemiology · 2026Article
- The promise of artificial intelligence in diagnostic breast pathology.Virchows Archiv : an international journal of pathology · 2026Article
- General practitioners' clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries.Scandinavian journal of primary health care · 2025Article
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- Deceptive Measures of "Success" in Early Cancer Detection.Current oncology (Toronto, Ont.) · 2024Review
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- Estimating Breast Cancer Overdiagnosis After Screening Mammography Among Older Women in the United States.Annals of internal medicine · 2023Article
- Behaviour within a Clinical Trial and Implications for Mammography Guidelines.The Review of economic studies · 2023Article
- Overdetection of Breast Cancer.Current oncology (Toronto, Ont.) · 2022Article
- The current status of risk-stratified breast screening.British journal of cancer · 2022Review
- Primary Care System Factors and Clinical Decision-making in Patients that Could Have Lung Cancer: a Vignette Study in Five Balkan Region Countries.Zdravstveno varstvo · 2022Article
- Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries.BMJ open · 2020Article
- Lead-time bias in esophageal cancer screening in high-risk areas in China.Chinese journal of cancer research = Chung-kuo yen cheng yen chiu · 2020Article
- 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
- Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials.Breathe (Sheffield, England) · 2020Review
- How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis.BMJ open · 2019Article
- Article
- Article
- Return on Investment Analysis of Breast Cancer Screening and Downstaging in Egypt: Implications for Developing Countries.Value in health regional issues · 2018Article
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPublished lead time estimates in breast cancer screening vary from 1 to 7 years and the percentages of overdiagnosis vary from 0 to 75%. The differences are usually explained as random variations. We study how much can be explained by using different definitions and methods.
methodsWe estimated the clinically relevant lead time based on the observed incidence reduction after attending the last screening round in the Norwegian mammography screening programme. We compared this estimate with estimates based on models that do not take overdiagnosis into account (model-based lead times), for varying levels of overdiagnosis. Finally, we calculated overdiagnosis adjusted for clinical and model-based lead times and compared results.
resultsClinical lead time was about one year based on the reduction in incidence in women previously offered screening. When overdiagnosed tumours were included, the estimates increased to 4-9 years, depending on the age at which screening begins and the level of overdiagnosis. Including all breast cancers detected in women long after the end of the screening programme dilutes the level of overdiagnosis by a factor of 2-3.
conclusionWhen overdiagnosis is not taken into account, lead time is substantially overestimated. Overdiagnosis adjusted for model-based lead time is a function tending to zero, with no simple interpretation. Furthermore, the estimates are not in general comparable, because they depend on both the duration of screening and duration of follow-up. In contrast, overdiagnosis adjusted for clinically relevant tumours is a point estimate (and interpreted as percentage), which we find is the most reasonable method.
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