Overdiagnosis in Mammographic Screening because of Competing Risk of Death

Falk, Ragnhild Sørum; Hofvind, Solveig

doi:10.1158/1055-9965.epi-15-0819

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…This study reported the frequency of overdiagnosis among a cohort of women over a period of 10 years after they participated in cancer screening. Falk et al estimated the number of women overdiagnosed in mammographic screening using English, Welsh, and Norwegian data (Falk et al, 2016). Moreover, Kilpeläinen et al, (2016) reported the association of prostate cancer with socioeconomic status in Finland.…”

Section: Discussionmentioning

confidence: 99%

Influence of Income on Cancer Incidence and Death among Patients in Aomori, Japan

Tanaka

Matsuzaka

Sasaki

2018

Asian Pac J Cancer Prev

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Background:Aomori Prefecture has experienced the highest cancer-related mortality rates since the 2000s in Japan. In addition, income of residents in Aomori Prefecture is lower than that of a countrywide average. Aims of this study were to examine the relationships of the incidence and mortality rates of common cancers (stomach, colorectal, liver, lung, breast, cervical, and prostate) with the income levels of residential income area and clarify the factors contributing to the high mortality rates in Aomori prefecture.Methods:We included data on all patients diagnosed with stomach, colorectal, liver, lung, breast, cervical, or prostate cancer in the Aomori cancer registry database between 2010 and 2012. Age-standardized incidence rates and incidence rate ratios were calculated. Risk of cancer mortality related to economic disparities was determined via multivariable Cox regression analysis and adjusted for age, sex, and stage at diagnosis in the multivariable model.Results:We identified 21,240 eligible cancer patients. There were no differences in AIRs and IRRs among patients with stomach, colorectal, or lung cancer according to income. Contrarily, AIRs and IRRs were higher in higher-income areas than in lower-income areas among patients with breast, cervical, or prostate cancer. There were no significant differences in HRs according to income for any cancer type.Conclusions:Patients with higher income were diagnosed with early-stage disease more frequently, and they had higher AIRs for breast, cervical, and prostate cancers than those with middle and low incomes. However, there were no significant differences in hazard ratios.

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Section: Discussionmentioning

confidence: 99%

Influence of Income on Cancer Incidence and Death among Patients in Aomori, Japan

Tanaka

Matsuzaka

Sasaki

2018

Asian Pac J Cancer Prev

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“…In Norway, the risk of overdiagnosis due to competing risk of death is thought to be less than 2%. 33 This paper thus limits its scope to discussing the former cause of overdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Women’s conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study

et al. 2021

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ObjectiveTo investigate conceptual knowledge about mammographic screening among Norwegian women.DesignWe administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia.SettingOur Norwegian-language survey was open from April to June 2020 and targeted women aged 45–74 years.Participants2033 women completed our questionnaire. We excluded 13 women outside the target age range and 128 women with incomplete data. Responses from 1892 women were included in the final study sample.Primary and secondary outcome measuresThe questionnaire focused on women’s knowledge about the breast cancer mortality reduction, false positive results and overdiagnosis associated with mammographic screening. The primary outcome was the mean number of marks assigned in each of the three themes and overall. There were three potential marks for questions about breast cancer mortality, one for false positives and six for overdiagnosis.ResultsMost women (91.7%) correctly reported that screened women are less likely to die of breast cancer than non-screened women. 39.7% of women reported having heard of a ‘false positive screening result’ and 86.2% identified the term’s definition; 51.3% of women had heard of ‘overdiagnosis’ and 14.8% identified the term’s definition. The mean score was 2.59 of 3 for questions about breast cancer mortality benefit and 0.93 of 1 for the question about false positive screening results. It was 2.23 of 6 for questions about overdiagnosis.ConclusionsMost participants correctly answered questions about the breast cancer mortality benefit and false positive results associated with screening. The proportion of correct responses to questions about overdiagnosis was modest, indicating that conceptual knowledge about overdiagnosis was lower. Qualitative studies that can obtain in-depth information about women’s understanding of overdiagnosis may help improve Norwegian-language information about this challenging topic.

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“…In a modeling study using data from England and Norway, Falk and Hofvind estimated that in a population offered screening, between 2% and 4% of women diagnosed with breast cancer would die from other causes within the estimated lead-time. 34 Owing to the reduced life expectancy, we expect this inevitable proportion of overdiagnosed breast cancer cases to be larger in women with than in women without chronic diseases.…”

Section: Discussionmentioning

confidence: 99%

Impact of chronic diseases on effect of breast cancer screening

et al. 2020

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Background Although breast cancer screening reduces breast cancer mortality at the population level, subgroups of women may benefit differently. We investigated the impact of health status on the effect of breast cancer screening. Methods The study included 181 299 women invited in two population‐based screening programs in Denmark and 1 526 446 control subjects, followed from April 1981 to December 2014. Poisson regressions were used to compare the observed breast cancer mortality rate in women invited to screening with the expected rate in the absence of screening among women with and without chronic diseases. Chronic diseases were defined as any diagnosis in the Charlson Comorbidity Index during 4 years before the first invitation to screening. Results Almost 10% of women had chronic diseases before first invitation to screening. Whereas we observed a reduction in breast cancer mortality following invitation to screening of 28% (95% CI, 20% to 35%) among women without chronic diseases, only a 7% (95% CI, −39% to 37%) reduction was seen for women with chronic diseases (P‐value for interaction = .22). For participants, the reduction, corrected for selection bias, was 35% (95% CI 16% to 49%) for women without, and 4% (95% CI −146% to 62%) for women with chronic diseases (P‐value for interaction = .43). Conclusion Our data indicate a marginal effect of mammography screening on breast cancer mortality in women with chronic diseases. If our results are confirmed in other populations, the presence of chronic diseases will be an important factor to take into consideration in personalized screening.

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Overdiagnosis in Mammographic Screening because of Competing Risk of Death

Cited by 9 publications

References 23 publications

Influence of Income on Cancer Incidence and Death among Patients in Aomori, Japan

Influence of Income on Cancer Incidence and Death among Patients in Aomori, Japan

Women’s conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study

Impact of chronic diseases on effect of breast cancer screening

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