Overdiagnosis and overtreatment of breast cancer: microsimulation modelling estimates based on observed screen and clinical data

Breast Cancer Research : BCR
Harry J de KoningArry de Bruijn

Abstract

There is a delicate balance between the favourable and unfavourable side-effects of screening in general. Overdiagnosis, the detection of breast cancers by screening that would otherwise never have been clinically diagnosed but are now consequently treated, is such an unfavourable side effect. To correctly model the natural history of breast cancer, one has to estimate mean durations of the different pre-clinical phases, transition probabilities to clinical cancer stages, and sensitivity of the applied test based on observed screen and clinical data. The Dutch data clearly show an increase in screen-detected cases in the 50 to 74 year old age group since the introduction of screening, and a decline in incidence around age 80 years. We had estimated that 3% of total incidence would otherwise not have been diagnosed clinically. This magnitude is no reason not to offer screening for women aged 50 to 74 years. The increases in ductal carcinoma in situ (DCIS) are primarily due to mammography screening, but DCIS still remains a relatively small proportion of the total breast cancer problem.

References

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Citations

Jun 29, 2011·Epidemiologic Reviews·Rianne de GelderHarry J de Koning
Nov 1, 2011·Current Opinion in Obstetrics & Gynecology·Karla Kerlikowske
Jul 23, 2011·Breast Care·Sylvia H Heywang-KöbrunnerStefan Sedlacek
Aug 5, 2010·Breast Cancer Research : BCR·Montserrat Martinez-AlonsoMontserrat Rue
Jan 16, 2010·Journal of the American Statistical Association·Carolyn M RutterJames E Savarino
Feb 6, 2014·PloS One·Ester VilaprinyoUNKNOWN Interval Cancer (INCA) Study Group
Nov 19, 2009·Annals of Internal Medicine·Heidi D NelsonUNKNOWN U.S. Preventive Services Task Force
Nov 19, 2009·Annals of Internal Medicine·Jeanne S MandelblattUNKNOWN Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network
Apr 1, 2015·Epidemiology and Health·Jong-Myon Bae
May 1, 2015·Breast Cancer Research : BCR·Magnus LøbergMette Kalager
Mar 20, 2018·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Nicolien T van RavesteynSandra J Lee
Nov 9, 2017·Journal of the National Cancer Institute·Theodora M RippingMireille J M Broeders
Mar 12, 2019·Statistical Methods in Medical Research·Linda AbrahamssonKeith Humphreys
Aug 31, 2019·Biomarkers in Medicine·Moritz HamannMarion Kiechle
Aug 9, 2008·International Journal of Cancer. Journal International Du Cancer·Johannes D M OttenAndré L M Verbeek
May 29, 2020·Breast Cancer Research : BCR·Sarocha ChootipongchaivatSandra J Lee
Jul 14, 2009·Deutsches Ärzteblatt International·Sylvia H Heywang-KöbrunnerAlexander Katalinic

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