Overdiagnosis and overtreatment associated with breast cancer mammography screening: A simulation study with calibration to population-based data

Seigneurin, Arnaud; Labarère, José; Ochsenbein, F.; Exbrayat, C.; Dupouy, Maylis; Filippi, Marc; Colonna, Marc

doi:10.1016/j.breast.2016.04.013

Cited by 22 publications

(13 citation statements)

References 21 publications

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“…Yen et al [13] also estimated that the proportion of the screendetected DCIS that is non-progressive (not progressing to IBC) varies from 19 to 46% in the prevalence screen and from 3 to 21% in the first subsequent screen. Another study by Seigneurin et al estimated that 20.3% (95% CI, 3.0-38.9%) of in situ cancer was overdiagnosed, assuming that non-progressive in situ cancer remains in the preclinical phase [44]. With regard to IBC in our study, overdiagnosis was on average between 1.3 and 2.4% regardless of the assumption of DCIS regression for the age group 30-79 years.…”

Section: Discussioncontrasting

confidence: 39%

Modeling the natural history of ductal carcinoma in situ based on population data

Chootipongchaivat

Ravesteyn

et al. 2020

Breast Cancer Res

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Background: The incidence of ductal carcinoma in situ (DCIS) has increased substantially since the introduction of mammography screening. Nevertheless, little is known about the natural history of preclinical DCIS in the absence of biopsy or complete excision. Methods: Two well-established population models evaluated six possible DCIS natural history submodels. The submodels assumed 30%, 50%, or 80% of breast lesions progress from undetectable DCIS to preclinical screendetectable DCIS; each model additionally allowed or prohibited DCIS regression. Preclinical screen-detectable DCIS could also progress to clinical DCIS or invasive breast cancer (IBC). Applying US population screening dissemination patterns, the models projected age-specific DCIS and IBC incidence that were compared to Surveillance, Epidemiology, and End Results data. Models estimated mean sojourn time (MST) in the preclinical screen-detectable DCIS state, overdiagnosis, and the risk of progression from preclinical screen-detectable DCIS. Results: Without biopsy and surgical excision, the majority of DCIS (64-100%) in the preclinical screen-detectable state progressed to IBC in submodels assuming no DCIS regression (36-100% in submodels allowing for DCIS regression). DCIS overdiagnosis differed substantially between models and submodels, 3.1-65.8%. IBC overdiagnosis ranged 1.3-2.4%. Submodels assuming DCIS regression resulted in a higher DCIS overdiagnosis than submodels without DCIS regression. MST for progressive DCIS varied between 0.2 and 2.5 years. Conclusions: Our findings suggest that the majority of screen-detectable but unbiopsied preclinical DCIS lesions progress to IBC and that the MST is relatively short. Nevertheless, due to the heterogeneity of DCIS, more research is needed to understand the progression of DCIS by grades and molecular subtypes.

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Section: Discussioncontrasting

confidence: 39%

Modeling the natural history of ductal carcinoma in situ based on population data

Chootipongchaivat

Ravesteyn

et al. 2020

Breast Cancer Res

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“…Identifiability poses an even bigger problem for more complex natural histories, such as the combination of in-situ and invasive cancers (12,29). For complex models that remain analytically tractable, structural identifiability analyses such as those described here may be conducted, but they may be technically challenging.…”

Section: Discussionmentioning

confidence: 99%

“…However, this approach can yield biased estimates even in the setting of randomized screening trials (8,9). A second method uses mathematical modeling to leverage the close link between overdiagnosis and disease natural history (10)(11)(12). Since overdiagnosis occurs when the period of disease latency, or sojourn time, of a screen-detected case extends beyond the date of othercause death, the frequency of overdiagnosis can be derived on the basis of an estimate of disease natural history (13).…”

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confidence: 99%

Identification of the Fraction of Indolent Tumors and Associated Overdiagnosis in Breast Cancer Screening Trials

Ryser

Gulati

Eisenberg

et al. 2018

American Journal of Epidemiology

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It is generally accepted that some screen-detected breast cancers are overdiagnosed and would not progress to symptomatic cancer if left untreated. However, precise estimates of the fraction of nonprogressive cancers remain elusive. In recognition of the weaknesses of overdiagnosis estimation methods based on excess incidence, there is a need for model-based approaches that accommodate nonprogressive lesions. Here, we present an in-depth analysis of a generalized model of breast cancer natural history that allows for a mixture of progressive and indolent lesions. We provide a formal proof of global structural identifiability of the model and use simulation to identify conditions that allow for parameter estimates that are sufficiently precise and practically actionable. We show that clinical follow-up after the last screening can play a critical role in ensuring adequately precise identification of the fraction of indolent cancers in a stop-screen trial design, and we demonstrate that model misspecification can lead to substantially biased estimates of mean sojourn time. Finally, we illustrate our findings using the example of Canadian National Breast Screening Study 2 (1980-1985) and show that the fraction of indolent cancers is not precisely identifiable. Our findings provide the foundation for extended models that account for both in situ and invasive lesions.

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“…Cancer screening programs have the potential to reduce mortality: in a SEER publication, the survival rate was 99% for breast cancer detected at a localized stage and 27% for metastatic cancer . The efficiency of screening in terms of mortality rates has been repeatedly challenged, however, since treatment has become more effective, primarily due to the diagnosis of lesions of questionable aggression—known as overdiagnosis—and the emergence of some cancers during the interval between two screenings . A large number of studies have examined the impact of breast cancer diagnosis in these terms, but few have evaluated its impact in terms of the extent of treatment .…”

Section: Introductionmentioning

confidence: 99%

“…5 The efficiency of screening in terms of mortality rates has been repeatedly challenged, however, since treatment has become more effective, primarily due to the diagnosis of lesions of questionable aggression-known as overdiagnosis-and the emergence of some cancers during the interval between two screenings. [6][7][8][9][10][11] A large number of studies have examined the impact of breast cancer diagnosis in these terms, but few have evaluated its impact in terms of the extent of treatment. [12][13][14][15] In France, the organized breast cancer screening program (SP) targets asymptomatic women aged between 50 and 74 years at average risk, that is, with no particular identified risk factors.…”

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confidence: 99%

Breast cancer screening: Impact on care pathways

et al. 2019

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Background Controversy persists concerning screening programs (SPs), related to a potential risk of overdiagnosis or the impact on survival. One of the main questions to be addressed concerns the aggressiveness of the related treatments. Methods Using the "Cancer Cohort,” a national‐based cohort (medico‐administrative database), all women between the ages of 50 and 74 years and treated in 2014 for incident breast cancer were compared, according to whether their diagnosis was made following a mammogram performed within the framework of the SP (SP group) or outside it (NSP group). Results A total of 23 788 women were identified: 13 530 (57%) in the SP group and 10 258 (43%) in the NSP group. The women in the SP group had a higher rate of in situ or localized invasive breast cancer. They had a higher rate of breast‐conserving surgery (82% vs 70%), and a lower rate of chemotherapy (34% vs 53%). These findings were observed irrespective of the stage. They had a higher rate of pathways involving breast‐conserving surgery followed by radiotherapy. Among women with metastatic cancer, those in the SP group had a lower proportion of liver, lung, brain, and bone metastases, and a higher proportion of lymph node metastases (other than axillary), irrespective of the time to onset of the metastases. Conclusion The women in whom cancer was diagnosed following a mammogram performed in the context of the SP had less advanced cancer and less aggressive treatments. This observational study helps illustrate the benefit of the SP in France using a different approach.

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Overdiagnosis and overtreatment associated with breast cancer mammography screening: A simulation study with calibration to population-based data

Cited by 22 publications

References 21 publications

Modeling the natural history of ductal carcinoma in situ based on population data

Modeling the natural history of ductal carcinoma in situ based on population data

Identification of the Fraction of Indolent Tumors and Associated Overdiagnosis in Breast Cancer Screening Trials

Breast cancer screening: Impact on care pathways

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