Overdiagnosis in cancer.

This article summarizes the phenomenon of cancer overdiagnosis-the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography-detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it.

[1]  Y. Nikiforov.  Is ionizing radiation responsible for the increasing incidence of thyroid cancer? , 2010, Cancer.

[2]  David Chia,et al.  Mortality results from a randomized prostate-cancer screening trial. , 2009, The New England journal of medicine.

[3]  B. G. Blijenberg,et al.  Screening and prostate-cancer mortality in a randomized European study. , 2009, The New England journal of medicine.

[4]  P. Gøtzsche,et al.  Breast screening: the facts—or maybe not , 2009, BMJ : British Medical Journal.

[5]  Stella K Kang,et al.  Distribution of renal tumor growth rates determined by using serial volumetric CT measurements. , 2009, Radiology.

[6]  L. Berland.  Incidental extracolonic findings on CT colonography: the impending deluge and its implications. , 2009, Journal of the American College of Radiology : JACR.

[7]  William W Mayo-Smith,et al.  The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. , 2008, AJR. American journal of roentgenology.

[8]  J. Gray,et al.  Screening: Evidence and Practice , 2019 .

[9]  R. Autorino,et al.  Clinicopathologic features of prostate adenocarcinoma incidentally discovered at the time of radical cystectomy: an evidence-based analysis. , 2007, European urology.

[10]  M. Serrano.  Cancer regression by senescence. , 2007, The New England journal of medicine.

[11]  O. Miettinen,et al.  Survival of Patients with Stage I Lung Cancer Detected on CT Screening , 2008 .

[12]  D. Peeper,et al.  Oncogene-induced cell senescence--halting on the road to cancer. , 2006, The New England journal of medicine.

[13]  K. Stamatiou,et al.  Incidence of impalpable carcinoma of the prostate and of non‐malignant and precarcinomatous lesions in Greek male population: An autopsy study , 2006, The Prostate.

[14]  E. Bergstralh,et al.  Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. , 2006, Journal of the National Cancer Institute.

[15]  Louise Davies,et al.  Increasing incidence of thyroid cancer in the United States, 1973-2002. , 2006, JAMA.

[16]  Steven Woloshin,et al.  Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers , 2006, BMJ : British Medical Journal.

[17]  Ingvar Andersson,et al.  Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study , 2006, BMJ : British Medical Journal.

[18]  E. Feuer,et al.  SEER Cancer Statistics Review, 1975-2003 , 2006 .

[19]  J. Austin,et al.  Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. , 2005, Radiology.

[20]  Lisa M. Schwartz,et al.  Skin biopsy rates and incidence of melanoma: population based ecological study , 2005, BMJ : British Medical Journal.

[21]  H. Welch,et al.  The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. , 2005, Journal of the National Cancer Institute.

[22]  Raghu Kalluri,et al.  Cancer without disease , 2004, Nature.

[23]  J Smith,et al.  Tobacco and cancer: recent epidemiological evidence. , 2004, Journal of the National Cancer Institute.

[24]  Frederick C Beddingfield.  The melanoma epidemic: res ipsa loquitur. , 2003, The oncologist.

[25]  P. Gosling.  DORLAND’S ILLUSTRATED MEDICAL DICTIONARY , 2003, Australasian Chiropractic & Osteopathy.

[26]  Harry J de Koning,et al.  Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. , 2003, Journal of the National Cancer Institute.

[27]  G. Braunstein,et al.  Management of the Clinically Inapparent Adrenal Mass (Incidentaloma) , 2003, Annals of Internal Medicine.

[28]  F. Berthold,et al.  Neuroblastoma screening at one year of age. , 2002, The New England journal of medicine.

[29]  J. Lau,et al.  Management of clinically inapparent adrenal mass. , 2002, Evidence report/technology assessment.

[30]  S. Sone,et al.  Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner , 2001, British Journal of Cancer.

[31]  G. Byrnes,et al.  Screening for lung cancer. , 2004, The Cochrane database of systematic reviews.

[32]  G. Bepler,et al.  Screening for lung cancer. , 2000, The New England journal of medicine.

[33]  Lisa M. Schwartz,et al.  Are increasing 5-year survival rates evidence of success against cancer? , 2000, JAMA.

[34]  E. Feuer,et al.  Role of transurethral resection of the prostate in population-based prostate cancer incidence rates. , 1999, American journal of epidemiology.

[35]  L. Dennis,et al.  Analysis of the melanoma epidemic, both apparent and real: data from the 1973 through 1994 surveillance, epidemiology, and end results program registry. , 1999, Archives of dermatology.

[36]  Feng Li,et al.  Mass screening for lung cancer with mobile spiral computed tomography scanner , 1998, The Lancet.

[37]  R. Hanada,et al.  Spontaneous regression of localized neuroblastoma detected by mass screening. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[38]  Welch Hg,et al.  Using Autopsy Series To Estimate the Disease “Reservoir” for Ductal Carcinoma in Situ of the Breast: How Much More Breast Cancer Can We Find? , 1997 .

[39]  R. Swerlick,et al.  The melanoma epidemic: more apparent than real? , 1997, Mayo Clinic proceedings.

[40]  H. Welch,et al.  Using Autopsy Series To Estimate the Disease Reservoir for Ductal Carcinoma in Situ of the Breast: How Much More Breast Cancer Can We Find? , 1997, Annals of Internal Medicine.

[41]  F. Bessho.  Where should neuroblastoma mass screening go? , 1996, The Lancet.

[42]  F. Bessho,et al.  Effects of mass screening on age‐specific incidence of neuroblastoma , 1996, International journal of cancer.

[43]  D. Grignon,et al.  Age and racial distribution of prostatic intraepithelial neoplasia. , 1996, European urology.

[44]  E. Bergstralh,et al.  Screening for lung cancer. A critique of the mayo lung project , 1991, Cancer.

[45]  K. Franssila,et al.  Occult papillary carcinoma of the thyroid. A “normal” finding in finland. A systematic autopsy study , 1985, Cancer.

[46]  W. A. Newman Dorland,et al.  Dorland's Illustrated Medical Dictionary , 1974 .

[47]  Illiam,et al.  SCREENING OF INFANTS AND MORTALITY DUE TO NEUROBLASTOMA , 2022 .