Estimation and Communication of Overdiagnosis in Cancer Screening

Overview

Overdiagnosis, or the detection by screening of cases that would never become clinically diagnosed, and associated treatment are the greatest potential harms of screening. Overdiagnosed cases cannot be helped by treatment and overtreatment of these cases carries a high price in terms of patient morbidity and economic costs. Knowledge about overdiagnosis is critical for well-formed screening policies and for well-informed patient decision making. However, overdiagnosis depends on screening practices and personal factors and many published studies are biased or do not apply to populations that differ from those used for estimation.

This work will advance knowledge about how to validly estimate overdiagnosis and to provide concrete information about overdiagnosis associated with specific cancer screening settings to inform screening policy development and clinical decision making. We will conduct a mathematical modeling study to identify acceptable approaches and key characteristics of valid overdiagnosis studies, apply these lessons to estimate overdiagnosis rates associated with breast and prostate cancer screening under different screening policies and for different population subgroups defined by patient and tumor characteristics, and make these estimates available to policy makers and clinicians via online calculators.

This activity is supported by a grant from the National Cancer Institute (R01 CA192402).

Researchers

Ruth Etzioni
Roman Gulati
Yu Shen
Jane Lange
Christoph Lee

Overview of aims in Overdiagnosis study
 

Publications

Gulati R, Psutka SP, Etzioni R. Personalized risks of overdiagnosis for screen-detected prostate cancer incorporating patient comorbidities: Estimation and communication. J Urol. 2019 May 21.

Ryser MD, Gulati R, Eisenberg MC, Shen Y, Hwang ES, Etzioni RB. Identification of the fraction of indolent tumors and associated overdiagnosis in breast cancer screening trials. Am J Epidemiol. 2019 Jan 1;188(1):197-205.

Shen Y, Dong W, Gulati R, Ryser MD, Etzioni R. Estimating the frequency of indolent breast cancer in screening trials. Stat Methods Med Res. 2018 Jan 1:962280217754232.

Lee CI, Etzioni R. Missteps in current estimates of cancer overdiagnosis. Acad Radiol. 2017 Feb;24(2):226-229.

Gulati R, Feuer EJ, Etzioni R. Conditions for valid empirical estimates of cancer overdiagnosis in randomized trials and population studies. Am J Epidemiol. 2016 Jul 15;184(2):140-7.

Etzioni R, Gulati R. Active surveillance for ductal carcinoma in situ: shining light into the modeling abyss. J Natl Cancer Inst. 2015 Dec 17;108(5).

Etzioni R, Gulati R. Recognizing the limitations of cancer overdiagnosis studies: a first step towards overcoming them. J Natl Cancer Inst. 2015 Nov 18;108(3).