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Overdiagnosis in cancer
H Gilbert Welch1, William C Black
1Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA. h.gilbert.welch@dartmouth.edu
Journal of the National Cancer Institute
|April 24, 2010
Summary
Cancer overdiagnosis occurs when detected cancers would not cause harm. Screening tests like mammograms and PSA tests lead to overdiagnosis, affecting breast, lung, and prostate cancer detection.
Area of Science:
- Oncology
- Medical Diagnostics
- Public Health
Background:
- Cancer overdiagnosis is the detection of a malignancy that would not have caused symptoms or death.
- It requires a silent disease reservoir and detection activities, such as cancer screening.
Purpose of the Study:
- To summarize the phenomenon of cancer overdiagnosis.
- To estimate the magnitude of overdiagnosis for various cancers.
- To discuss strategies for addressing overdiagnosis.
Main Methods:
- Analysis of randomized trials for overdiagnosis estimates.
- Review of observational studies and population-based cancer statistics.
- Examination of screening-detected cancers.
Main Results:
- Overdiagnosis rates: 25% for mammographically detected breast cancer, 50% for chest x-ray/sputum-detected lung cancer, 60% for PSA-detected prostate cancer.
- Evidence suggests overdiagnosis in CT-detected lung cancer, neuroblastoma, thyroid, melanoma, and kidney cancers.
- Early detection trade-offs require adequate patient information.
Conclusions:
- Cancer overdiagnosis is a significant issue in early detection and screening.
- Improved patient education on screening trade-offs is crucial.
- Further research is needed to refine overdiagnosis estimates and develop mitigation strategies.
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