Income and Cancer Overdiagnosis — When Too Much Care Is Harmful
Abstract
There are reasons to wonder whether people with higher incomes receive too much medical care. Cancer screening is one area where overutilization can cause harm, resulting in overdiagnosis and potentially unnecessary treatment.
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Cancer diagnosis is an imperfect proxy for cancer incidence, so rates of surveillance-sensitive cancers (e.g., thyroid and breast cancer) are inflated in affluent compared to underserved communities.
“Because cancer diagnosis is an imperfect proxy for cancer incidence, rates of “surveillance-sensitive” cancers (e.g., thyroid and breast cancer) are inflated in affluent compared to underserved communities24.”
From Predictably unequal: understanding and addressing concerns that algorithmic clinical prediction may increase health disparities (2020) · cites this paper as [24]
Cites
The Association Between Income and Life Expectancy in the United States, 2001–2014
Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016) · JAMA · doi:10.1001/jama.2016.4226 · Cited by 2,812 · see citing works
Welch, H. G., & Black, W. C. (2010) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djq099 · Cited by 1,601 · see citing works
Self-citationINEQUALITIES IN DEATH—SPECIFIC EXPLANATIONS OF A GENERAL PATTERN?
Marmot, M. G., Shipley, M. J., & Rose, G. (1984) · The Lancet · doi:10.1016/s0140-6736(84)92337-7 · Cited by 1,461 · see citing works
Schwartz, A. L., Chernew, M. E., Landon, B. E., & McWilliams, J. M. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.4525 · Cited by 165 · see citing works
Too Little? Too Much? Primary Care Physicians' Views on US Health Care
Sirovich, B. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.437 · Cited by 139 · see citing works
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The future of early cancer detection
Fitzgerald, R. C., Antoniou, A. C., Fruk, L., & Rosenfeld, N. (2022) · Nature Medicine · doi:10.1038/s41591-022-01746-x · Cited by 475 · see citing works
Cluzeau, T., Sebert, M., Rahmé, R., Cuzzubbo, S., Lehmann-Che, J., Madelaine, I., Peterlin, P., Bève, B., Attalah, H., Chermat, F., et al. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.20.02342 · Cited by 279 · see citing works
Paulus, J. K., & Kent, D. M. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0304-9 · Cited by 274 · see citing works
Health Impacts of Low-Dose Ionizing Radiation: Current Scientific Debates and Regulatory Issues
Vaiserman, A. M., Koliada, A. K., Геннадьевна, З. О., & Socol, Y. (2018) · Dose-Response · doi:10.1177/1559325818796331 · Cited by 227 · see citing works
Cytarabine and daunorubicin for the treatment of acute myeloid leukemia
Murphy, T., & Yee, K. W. L. (2017) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2017.1391216 · Cited by 169 · see citing works
Overdiagnosis in primary care: framing the problem and finding solutions
Kale, M., & Korenstein, D. R. (2018) · BMJ · doi:10.1136/bmj.k2820 · Cited by 168 · see citing works
Essien, U. R., Holmes, D. N., Jackson, L. R., Fonarow, G. C., Mahaffey, K. W., Reiffel, J. A., Steinberg, B. A., Allen, L. A., Chan, P. S., Freeman, J. V., et al. (2018) · JAMA Cardiology · doi:10.1001/jamacardio.2018.3945 · Cited by 155 · see citing works
How I manage monoclonal gammopathy of undetermined significance
Go, R. S., & Rajkumar, S. V. (2017) · Blood · doi:10.1182/blood-2017-09-807560 · Cited by 141 · see citing works
Disparities in Cancer Prevention in the COVID-19 Era
Carethers, J. M., Sengupta, R., Blakey, R., Ribas, A., & DʼSouza, G. (2020) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-20-0447 · Cited by 111 · see citing works
Genetic abnormalities and pathophysiology of MDS
Hosono, N. (2019) · International Journal of Clinical Oncology · doi:10.1007/s10147-019-01462-6 · Cited by 108 · see citing works
Ullmann, T. M., Gray, K. D., Stefanova, D. I., Limberg, J. N., Buicko, J. L., Finnerty, B. M., Zarnegar, R., Fahey, T. J., & Beninato, T. M. (2019) · Surgery · doi:10.1016/j.surg.2019.03.002 · Cited by 94 · see citing works
Co-Design of a Trustworthy AI System in Healthcare: Deep Learning Based Skin Lesion Classifier
Zicari, R. V., Ahmed, S., Amann, J., Braun, S. A., Brodersen, J., Bruneault, F., Brusseau, J., Campano, E., Coffee, M. P., Dengel, A. R., et al. (2021) · Frontiers in Human Dynamics · doi:10.3389/fhumd.2021.688152 · Cited by 69 · see citing works
Liu, Z. Z., Li, X., Gao, Y., Liu, J., Feng, Y.-T., Yang, L., Wang, J., Wang, C., Wang, D., He, J., et al. (2023) · Molecular Cancer · doi:10.1186/s12943-023-01768-0 · Cited by 65 · see citing works
Why Has Breast Cancer Screening Failed to Decrease the Incidence of de Novo Stage IV Disease?
Heller, D. R., Chiu, A. S., Farrell, K., Killelea, B. K., & Lannin, D. R. (2019) · Cancers · doi:10.3390/cancers11040500 · Cited by 38 · see citing works
Overdiagnosis in malignant melanoma: a scoping review
Bjørch, M. F., Gram, E. G., & Brodersen, J. (2023) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2023-112341 · Cited by 36 · see citing works
Ladin, K., Cuddeback, J. K., Duru, O. K., Goel, S., Harvey, W., Park, J. G., Paulus, J. K., Sackey, J., Sharp, R. R., Steyerberg, E. W., et al. (2024) · npj Digital Medicine · doi:10.1038/s41746-024-01245-y · Cited by 36 · see citing works
Time to abandon early detection cancer screening
Adami, H., Kalager, M., Valdimarsdóttir, U. A., Bretthauer, M., & Ioannidis, J. P. A. (2018) · European Journal of Clinical Investigation · doi:10.1111/eci.13062 · Cited by 34 · see citing works
Association of UV Radiation Exposure, Diagnostic Scrutiny, and Melanoma Incidence in US Counties
Adamson, A. S., Welch, H., & Welch, H. G. (2022) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2022.4342 · Cited by 34 · see citing works
Self-citationLiu, Y., Lai, F., Long, J., Peng, S., Wang, H., Zhou, Q., Ли, Б., Su, L., Gan, L., Shi, Y., et al. (2020) · International Journal of Cancer · doi:10.1002/ijc.33298 · Cited by 33 · see citing works
Davies, A. M., Patel, A., Botchu, R., Azzopardi, C., James, S., & Jeys, L. M. (2021) · Journal of Clinical Orthopaedics and Trauma · doi:10.1016/j.jcot.2021.02.017 · Cited by 32 · see citing works
Lived Experiences and Fear of Cancer Recurrence Among Survivors of Localized Cutaneous Melanoma
Mahama, A. N., Haller, C. N., Labrada, J., Idiong, C. I., Haynes, A. B., Jacobs, E. A., Tsevat, J., Pignone, M. P., & Adamson, A. S. (2024) · JAMA Dermatology · doi:10.1001/jamadermatol.2023.6158 · Cited by 28 · see citing works
Impact of Rurality on National Trends in Thyroid Cancer Incidence and Long‐Term Survival
McDow, A. D., Zahnd, W. E., Angelos, P., Mellinger, J. D., & Ganai, S. (2019) · The Journal of Rural Health · doi:10.1111/jrh.12374 · Cited by 28 · see citing works
Behaviour within a Clinical Trial and Implications for Mammography Guidelines
Kowalski, A. (2022) · The Review of Economic Studies · doi:10.1093/restud/rdac022 · Cited by 26 · see citing works
Alfonso, J. H., Martinsen, J. I., Weiderpass, E., Pukkala, ., Kjærheim, K., Tryggvadóttír, L., & Lynge, E. (2020) · British Journal of Dermatology · doi:10.1111/bjd.19379 · Cited by 21 · see citing works
Broadening risk factor or disease definition as a driver for overdiagnosis: A narrative review
Bandovas, J. P., Leal, B., Reis‐de‐Carvalho, C., Sousa, D. C., Araújo, J. C., Peixoto, P., Henriques, S. O., Carneiro, A. V., & the Choosing Wisely Working Group of the European Federation of Internal Medicine (2022) · Journal of Internal Medicine · doi:10.1111/joim.13465 · Cited by 21 · see citing works
Kang, H., Kim, I., Kim, Y.-Y., Bahk, J., & Khang, Y. (2020) · BMC Cancer · doi:10.1186/s12885-020-07597-4 · Cited by 21 · see citing works
The economics of diagnostic safety
Slawomirski, L., Kelly, D., de Bienassis, K., Kallas, K.-A., & Klazinga, N. (2025) · OECD Health Working Papers · doi:10.1787/fc61057a-en · Cited by 20 · see citing works
van der Giessen, J. A. M., Riel, E. V., Velthuizen, M. E., van Dulmen, S., & Ausems, M. G. E. M. (2017) · Journal of Community Genetics · doi:10.1007/s12687-017-0326-4 · Cited by 19 · see citing works
Racial Disparities in Cancer Presentation and Outcomes: The Contribution of Overdiagnosis
Marcadis, A. R., Davies, L., Marti, J. L., & Morris, L. G. T. (2020) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkaa001 · Cited by 14 · see citing works
Gram, E. G., Haas, R., Niklasson, A., Woloshin, S., Kramer, B. S., Brodersen, J., Jørgensen, K. J., Johansson, M., Wilt, T. J., & Bell, K. (2025) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2025-113874 · Cited by 13 · see citing works
Pang, H. Y. M., Chalmers, K., Landon, B. E., Elshaug, A. G., Matelski, J. J., Ling, V., Krzyzanowska, M. K., Kulkarni, G. S., Erickson, B. A., & Cram, P. M. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.5477 · Cited by 11 · see citing works
Sajid, I. M., Frost, K., & Paul, A. K. (2021) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2020-111629 · Cited by 12 · see citing works
Correcting a decade of negative news about mammography
Schattner, E. J. (2019) · Clinical Imaging · doi:10.1016/j.clinimag.2019.03.011 · Cited by 11 · see citing works
Otonari, J., Ikezaki, H., Furusyo, N., & Sudo, N. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110422 · Cited by 11 · see citing works
Emerging pharmacotherapies for elderly acute myeloid leukemia patients
Thomas, X., Elhamri, M., & Heiblig, M. (2020) · Expert Review of Hematology · doi:10.1080/17474086.2020.1758058 · Cited by 11 · see citing works
Golan, R., Bernstein, A., Gu, X., Dinerman, B. F., Sedrakyan, A., & Hu, J. C. (2018) · Cancer · doi:10.1002/cncr.31297 · Cited by 9 · see citing works
Marzo‐Castillejo, M., & Vallespín, C. V. (2018) · Atención Primaria · doi:10.1016/j.aprim.2018.08.002 · Cited by 9 · see citing works
Linking high-risk preventive strategy to biomedical-industry market: implications for public health
Norman, A. H., Hunter, D. J., & Russell, A. (2017) · Saúde e Sociedade · doi:10.1590/s0104-12902017172682 · Cited by 8 · see citing works
Chang, Y., Hwang, S.-H., Cho, S.-A., Lee, H., Cho, E., & Lee, J. Y. (2023) · Cancer Research and Treatment · doi:10.4143/crt.2023.650 · Cited by 7 · see citing works
Ellenbogen, M. I., Prichett, L. M., Johnson, P. T., & Brotman, D. J. (2021) · Journal of Hospital Medicine · doi:10.12788/jhm.3547 · Cited by 7 · see citing works
Sturmberg, J. P. (2019) · Springer eBooks · doi:10.1007/978-3-030-10940-0_1 · Cited by 6 · see citing works
Disparities in Cancer Incidence across Income Levels in South Korea
Jeong, S.-M., Jung, K., Park, J., Kim, N., Shin, D. W., & Suh, M. (2023) · Cancers · doi:10.3390/cancers15245898 · Cited by 6 · see citing works
Zhou, G., Xu, D. M., Zhang, B., Su, R., Xu, K., Zhang, X., Li, F., Zhao, W., & Cai, T. (2024) · International Journal of Hyperthermia · doi:10.1080/02656736.2024.2438853 · Cited by 5 · see citing works
do Nascimento, G. T. M., Pereira, I. C., de Oliveira, K. G. F., Santos, Á. M. C. P., do Nascimento, M. L. L. B., Porto, J. C. S., Torres-Leal, F. L., da Silva, F. C., Ferreira, J. R. D. O., Ferreira, P. M. P., et al. (2025) · Medical Oncology · doi:10.1007/s12032-025-02849-4 · Cited by 5 · see citing works
Characterizing the Relationship Between Payer Mix and Diagnostic Intensity at the Hospital Level
Ellenbogen, M. I., Prichett, L. M., & Brotman, D. J. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07453-0 · Cited by 5 · see citing works
Mammography Coverage and Tumor Stage in the Opportunistic Screening Context
Magario, M. B., Poli‐Neto, O. B., Tiezzi, D. G., Carrara, H. H. A., de Andrade, J. M., & dos Reis, F. J. C. (2019) · Clinical Breast Cancer · doi:10.1016/j.clbc.2019.04.014 · Cited by 5 · see citing works
Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits
Hur, K., Gibbons, J., & Finch, B. K. (2020) · Otolaryngology · doi:10.1177/0194599820913495 · Cited by 5 · see citing works
Goldberg, H., Noorani, R., Benton, J. Z., Lodh, A., Berlín, A., Chandrasekar, T., Wallis, C. J. D., Ahmad, A. E., Klaassen, Z. W. A., & Fleshner, N. E. (2020) · Cancer Causes & Control · doi:10.1007/s10552-020-01355-4 · Cited by 5 · see citing works
Le, T. T. T., & Adler, F. R. (2020) · PLoS Computational Biology · doi:10.1371/journal.pcbi.1008036 · Cited by 4 · see citing works
The inverse care law: overutilization of health services and overdiagnosis
Vaccarella, S., & Davies, L. (2019) · Europe PMC (PubMed Central) · Cited by 4 · see citing works
Lai, F., Pei, L., Yue, S., Cao, X., Xiao, H., Li, Y., & Li, J. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-042432 · Cited by 3 · see citing works
paradoxo da popularidade no rastreamento mamográfico e a prevenção quaternária
Tesser, C. D. (2023) · Revista Brasileira de Medicina de Família e Comunidade · doi:10.5712/rbmfc18(45)3487 · Cited by 4 · see citing works
Sobrediagnóstico (overdiagnosis) y sobretratamiento (overtreatment). ¿Más es mejor?
Garcia-Alamino, J. M., & Cano, M. L. (2022) · Cirugía Española · doi:10.1016/j.ciresp.2022.06.013 · Cited by 3 · see citing works
Adamson, A. S., Patel, V. R., & Welch, H. G. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-084955 · Cited by 2 · see citing works
Self-citationGardner, J. W., & Childs, S. (2022) · Quality Management Journal · doi:10.1080/10686967.2022.2034492 · Cited by 3 · see citing works
Overdiagnosis and overtreatment — More is better?
Garcia-Alamino, J. M., & Cano, M. L. (2022) · Cirugía Española (English Edition) · doi:10.1016/j.cireng.2022.06.053 · Cited by 2 · see citing works
The Importance of Population-Based Estimates of Melanocytic Pathology
Bell, K., Cust, A. E., & Scolyer, R. A. (2017) · JAMA Dermatology · doi:10.1001/jamadermatol.2017.4061 · Cited by 2 · see citing works
A multi-analyte serum biomarker panel for early detection of pancreatic adenocarcinomaPreprint
Firpo, M. A., Boucher, K. M., Bleicher, J. M., Khanderao, G. D., Rosati, A., Poruk, K. E., Kamal, S., Marzullo, L., Marco, M. D., Falco, A., et al. (2022) · medRxiv · doi:10.1101/2022.03.03.22271867 · Cited by 2 · see citing works
Dujon, A. M., Courtalon, J., Asselin, K., & Frédéric Thomas, A. (2026) · Proceedings of the Royal Society B Biological Sciences · doi:10.1098/rspb.2026.0504 · Cited by 1 · see citing works
Chen, Y., Gutierrez, V., Morris, L. G. T., & Marti, J. L. (2023) · Cureus · doi:10.7759/cureus.42439 · Cited by 1 · see citing works
Suzanne O’Sullivan interview: Is modern medicine overdiagnosing?
Macdonald, H., & Looi, M.-K. (2025) · BMJ · doi:10.1136/bmj.r1012 · Cited by 1 · see citing works
Re: A History of Pivotal Advances in Clinical Research Into Bone and Mineral Diseases
Miller, P. D., Bilezikian, J. P., Lewiecki, E. M., Watts, N. B., & CAREY, J. J. (2018) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.3566 · Cited by 1 · see citing works
Warshaw, A. L. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000002516
Knopf, A., Teutsch, S., & Bier, H. (2021) · BMC Health Services Research · doi:10.1186/s12913-020-06035-2
Equal access to breast cancer genetic counseling and testing
van der Doelen, J. A. M. (2021) · doi:10.33540/899
Su, C. T. (2018) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-18-00013.1
Zhou, G., Xu, D. M., Zhang, B., Su, R., Xu, K., Zhang, X., Li, F., Zhao, W., & Cai, T. (2024) · Research Square · doi:10.21203/rs.3.rs-4734711/v1
A importância do dissenso interno às ciências: o caso do rastreamento mamográfico do câncer de mama
Tesser, C. D. (2024) · Saúde e Sociedade · doi:10.1590/s0104-12902024230382pt
Evidence for a Causal Pathway Between Socioeconomic Status and Melanoma in SituPreprint
Dube, U., & Lin, J. Y. (2025) · medRxiv · doi:10.1101/2025.04.23.25326166
Martín-Moro, J. G., Ventura-Abreu, N., Zarallo-Gallardo, J., & Muñoz-Negrete, F. J. (2025) · Archivos de la Sociedad Española de Oftalmología (English Edition) · doi:10.1016/j.oftale.2025.04.013
Martín-Moro, J. G., Ventura-Abreu, N., Zarallo-Gallardo, J., & Muñoz-Negrete, F. J. (2025) · Archivos de la Sociedad Española de Oftalmología · doi:10.1016/j.oftal.2024.12.008
Zhang, H., Cai, Y., Jiang, Y., Fang, J., Qiu, W., Chen, D., Hu, Z., & Peng, X. (2025) · BMC Public Health · doi:10.1186/s12889-025-25148-z
Kang, H.-Y., Kim, I., Kim, Y.-Y., Bahk, J., & Khang, Y.-H. (2020) · Figshare · doi:10.6084/m9.figshare.13225579
Kang, H.-Y., Kim, I., Kim, Y.-Y., Bahk, J., & Khang, Y.-H. (2020) · Figshare · doi:10.6084/m9.figshare.13225576
Gram, E. G., Siersma, V., Brodersen, J. B., Nicolaisdóttir, D. R., & Rogvi, J. Á. (2025) · Public Health · doi:10.1016/j.puhe.2025.106113
Neighborhood-level socioeconomic disadvantage and pancreatic cancer among veterans
Levinson, R. N., Bushman, R., Mezzacappa, C., Tate, J. P., Justice, A. C., & Wang, L. L. (2026) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkag012
Yaver, M. (2026) · doi:10.1017/9781009649803.012
- Authors
- Welch, H. G., & Fisher, E. S.
- Affiliations
- Dartmouth College (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-06-08
- Volume
- 376
- Issue
- 23
- Pages
- 2208-2209
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2624051777
- Cited by
- 77
- References
- 5
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 10 · 2020: 12 · 2019: 9 · 2018: 8 · 2017: 6
- FWCI
- 15.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- income inequality, cancer screening, unnecessary treatment, socioeconomic status, health care utilization
- MeSH terms
- Medical Overuse, Humans, Income, Neoplasms, United States, Incidence, SEER Program, Healthcare Disparities, Early Detection of Cancer
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