TY - JOUR
T1 - Lead time and overdiagnosis in prostate-specific antigen screening
T2 - Importance of methods and context
AU - Draisma, Gerrit
AU - Etzioni, Ruth
AU - Tsodikov, Alex
AU - Mariotto, Angela
AU - Wever, Elisabeth
AU - Gulati, Roman
AU - Feuer, Eric
AU - De Koning, Harry
N1 - Funding Information:
The following grant information was disclosed by the authors: Guizhou Province Science and Technology Innovation Talent Team Project: [2021]004. Guizhou Provincial Department of Education Youth Science and Technology Talents Growth Project: [2018]103. Introducing Talent Research Program for Guizhou University: [2016]70. National Nature Science Foundation of Guizhou University Cultivating Program: [2017] 5788-32. Graduate Innovation Fund, Guizhou Province, China: [2019]023.
Funding Information:
This research was supported by the Guizhou Province Science and Technology Innovation Talent Team Project (No. Qian Ke He Pingtai Rencai – CXTD [2021]004), the Guizhou Provincial Department of Education Youth Science and Technology Talents Growth Project (No. Qian Jiao He KY word [2018]103), the Introducing Talent Research Program for Guizhou University (No. Gui Da Ren Ji He word [2016]70); the National Nature Science Foundation of Guizhou University Cultivating Program (No. Qian Ke He Platform Talent [2017]5788-32), and the Graduate Innovation Fund, Guizhou Province, China (No. Qianjiaohe YJSCXJH [2019]023). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
PY - 2009/3
Y1 - 2009/3
N2 - 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.ResultsThe 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.ConclusionThe precise definition and the population used to estimate lead time and overdiagnosis can be important drivers of study results and should be clearly specified.
AB - 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.ResultsThe 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.ConclusionThe 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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U2 - 10.1093/jnci/djp001
DO - 10.1093/jnci/djp001
M3 - Article
C2 - 19276453
AN - SCOPUS:64949135826
SN - 0027-8874
VL - 101
SP - 374
EP - 383
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 6
ER -