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Lead Time and Overdiagnosis in Prostate-Specific Antigen Screening: Importance of Methods and Context
Open accessAbstract
BACKGROUND: The time by which prostate-specific antigen (PSA) screening advances prostate cancer diagnosis, called the lead time, has been reported by several studies, but results have varied widely, with mean lead times ranging from 3 to 12 years. A quantity that is closely linked with the lead time is the overdiagnosis frequency, which is the fraction of screen-detected cancers that would not have been diagnosed in the absence of screening. Reported overdiagnosis estimates have also been variable, ranging from 25% to greater than 80% of screen-detected cancers. METHODS: We used three independently developed mathematical models of prostate cancer progression and detection that were calibrated to incidence data from the Surveillance, Epidemiology, and End Results program to estimate lead times and the fraction of overdiagnosed cancers due to PSA screening among US men aged 54-80 years in 1985-2000. Lead times were estimated by use of three definitions. We also compared US and earlier estimates from the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) that were calculated by use of a microsimulation screening analysis (MISCAN) model. RESULTS: The models yielded similar estimates for each definition of lead time, but estimates differed across definitions. Among screen-detected cancers that would have been diagnosed in the patients' lifetimes, the estimated mean lead time ranged from 5.4 to 6.9 years across models, and overdiagnosis ranged from 23% to 42% of all screen-detected cancers. The original MISCAN model fitted to ERSPC Rotterdam data predicted a mean lead time of 7.9 years and an overdiagnosis estimate of 66%; in the model that was calibrated to the US data, these were 6.9 years and 42%, respectively. CONCLUSION: The precise definition and the population used to estimate lead time and overdiagnosis can be important drivers of study results and should be clearly specified.
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Cited by
Global cancer statistics, 2012
Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet‐Tieulent, J., & Jemal, A. (2015) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21262 · Cited by 26,850
Siegel, R. L., Miller, K. D., & Jemal, A. (2016) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21332 · Cited by 16,003
“Routine screening with the PSA test is no longer recommended because of growing concerns about high rates of overdiagnosis, estimated at 23% to 42% for screen-detected cancers.(27,28) Despite declines in the prevalence of PSA screening from 2010 to 2013, one-third of men aged 65 years and older with limited life expec…”
BackgroundGlobal patterns of cancer incidence and mortality rates and trends
Jemal, A., Center, M. M., DeSantis, C., & Ward, E. M. (2010) · Cancer Epidemiology, Biomarkers & Prevention · doi:10.1158/1055-9965.epi-10-0437 · Cited by 2,778
Epidemiology of Prostate Cancer
Rawla, P. (2019) · World Journal of Oncology · doi:10.14740/wjon1191 · Cited by 2,776
Edwards, B. K., Ward, E., Kohler, B. A., Eheman, C., Zauber, A. G., Anderson, R. N., Jemal, A., Schymura, M. J., Lansdorp‐Vogelaar, I., Seeff, L. C., et al. (2010) · Cancer · doi:10.1002/cncr.24760 · Cited by 2,002
Metadata
- Authors
- Draisma, G., Etzioni, R., Tsodikov, A., Mariotto, A., Wever, E., Gulati, R., Feuer, E., & de Koning, H.
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-03-10
- Volume
- 101
- Issue
- 6
- Pages
- 374-383
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2100142491
- Cited by
- 796
- References
- 0
- FWCI
- 51.33
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Draisma, G., Etzioni, R., Tsodikov, A., Mariotto, A., Wever, E., Gulati, R., Feuer, E., & de Koning, H. (2009). Lead Time and Overdiagnosis in Prostate-Specific Antigen Screening: Importance of Methods and Context. JNCI Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djp001
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