Overdiagnosis in Cancer

J Natl Cancer Inst. 2010 May 5;102(9):605-13. doi: 10.1093/jnci/djq099. Epub 2010 Apr 22.

Abstract

This article summarizes the phenomenon of cancer overdiagnosis-the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography-detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Biomarkers, Tumor / blood*
  • Biopsy
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / epidemiology
  • Disease Progression
  • Early Detection of Cancer
  • Female
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / epidemiology
  • Male
  • Mammography
  • Mass Screening* / methods
  • Mass Screening* / trends
  • Neoplasm Staging
  • Neoplasms / diagnosis*
  • Neoplasms / epidemiology*
  • Neoplasms / mortality
  • Neoplasms / pathology
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / epidemiology
  • Randomized Controlled Trials as Topic
  • SEER Program
  • Thyroid Neoplasms / diagnosis
  • Thyroid Neoplasms / epidemiology
  • United States / epidemiology

Substances

  • Biomarkers, Tumor
  • Prostate-Specific Antigen