ArticleAmerican journal of epidemiology2019
Identification of the Fraction of Indolent Tumors and Associated Overdiagnosis in Breast Cancer Screening Trials.
Article in American journal of epidemiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed.
- Estimating the Opportunity for Early Detection of Ovarian Cancer Using Individual-Patient Data from a Large Randomized Controlled Trial.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025Trial
- Rural-urban and educational gradients in head and neck cancer incidence in Finland from 1977 to 2021.Acta oncologica (Stockholm, Sweden) · 2025Article
- Sensitivity Measures in Studies of Cancer Early Detection Biomarkers.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025Article
- Revisiting the standard blueprint for biomarker development to address emerging cancer early detection technologies.Journal of the National Cancer Institute · 2024Review
- Risk of cancer versus risk of cancer diagnosis? Accounting for diagnostic bias in predictions of breast cancer risk by race and ethnicity.Journal of medical screening · 2023Article
- Estimating stage-specific sensitivity for cancer screening tests.Journal of medical screening · 2023Article
- Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort.Annals of internal medicine · 2022Article
- Trade-Offs Between Harms and Benefits of Different Breast Cancer Screening Intervals Among Low-Risk Women.Journal of the National Cancer Institute · 2021Article
- Assessing model mismatch and model selection in a Bayesian uncertainty quantification analysis of a fluid-dynamics model of pulmonary blood circulation.Journal of the Royal Society, Interface · 2020Article
- Full observability and estimation of unknown inputs, states and parameters of nonlinear biological models.Journal of the Royal Society, Interface · 2019Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
It is generally accepted that some screen-detected breast cancers are overdiagnosed and would not progress to symptomatic cancer if left untreated. However, precise estimates of the fraction of nonprogressive cancers remain elusive. In recognition of the weaknesses of overdiagnosis estimation methods based on excess incidence, there is a need for model-based approaches that accommodate nonprogressive lesions. Here, we present an in-depth analysis of a generalized model of breast cancer natural history that allows for a mixture of progressive and indolent lesions. We provide a formal proof of global structural identifiability of the model and use simulation to identify conditions that allow for parameter estimates that are sufficiently precise and practically actionable. We show that clinical follow-up after the last screening can play a critical role in ensuring adequately precise identification of the fraction of indolent cancers in a stop-screen trial design, and we demonstrate that model misspecification can lead to substantially biased estimates of mean sojourn time. Finally, we illustrate our findings using the example of Canadian National Breast Screening Study 2 (1980-1985) and show that the fraction of indolent cancers is not precisely identifiable. Our findings provide the foundation for extended models that account for both in situ and invasive lesions.
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