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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention

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Research Article

Overdiagnosis in Mammographic Screening because of Competing Risk of Death

Ragnhild Sorum Falk and Solveig Hofvind
Ragnhild Sorum Falk
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
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Solveig Hofvind
Department of Screening, Cancer Registry of Norway, Oslo, Norway.Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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  • For correspondence: solveig.hofvind@kreftregisteret.no
DOI: 10.1158/1055-9965.EPI-15-0819
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Abstract

Background: Different definitions and estimates of overdiagnosis in mammographic screening reflect a substantial need to investigate and understand the complexity of the issue. This modeling study aims to estimate the number of overdiagnosed women, defined as those diagnosed with breast cancer who die from any cause within the lead-time period.

Methods: We used numbers from incidence and death statistics available online and published estimates of lead-time. Postulated cohorts of screened and not screened women ages 50 to 51 were followed for a period corresponding to 10 biennial screening exams during 20 years, and a further 10 years, to ages 78 to 79. The increase in breast cancer incidence because of screening was estimated based on lead-time. The proportion of women diagnosed with breast cancer who died within the lead-time period was assessed based on the differences in the cumulative number of breast cancer diagnosed in a nonscreened and screened cohort.

Results: The proportion of inevitable overdiagnosed women in a screened versus nonscreened cohort was 1.9% for England and Wales and 1.8% for Norway. Sensitivity analyses using various assumptions increased the estimates up to a maximum of 4%.

Conclusion: The proportion of women with breast cancer diagnosed after participation in a screening program who died within the estimated lead-time period was less than 4%. This inevitable proportion of overdiagnosis should be emphasized in the definition and communication of the issue.

Impact: The issue of overdiagnosis is complex and estimates should be interpreted with substantial care. Cancer Epidemiol Biomarkers Prev; 25(5); 1–7. ©2016 AACR.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Received August 11, 2015.
  • Revision received January 20, 2016.
  • Accepted January 29, 2016.
  • ©2016 American Association for Cancer Research.
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Published OnlineFirst April 15, 2016
doi: 10.1158/1055-9965.EPI-15-0819

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Overdiagnosis in Mammographic Screening because of Competing Risk of Death
Ragnhild Sorum Falk and Solveig Hofvind
Cancer Epidemiol Biomarkers Prev April 15 2016 DOI: 10.1158/1055-9965.EPI-15-0819

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Overdiagnosis in Mammographic Screening because of Competing Risk of Death
Ragnhild Sorum Falk and Solveig Hofvind
Cancer Epidemiol Biomarkers Prev April 15 2016 DOI: 10.1158/1055-9965.EPI-15-0819
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Cancer Epidemiology, Biomarkers & Prevention
eISSN: 1538-7755
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