Overdiagnosis in Cancer

The full article is hiding behind a pay wall but at least this abstract can give us some idea of the possible degree of over-diagnosis in cancers.

I don’t understand why the National Cancer Institute is putting this information behind a pay wall.  

from the Journal of the National Cancer Institute

written by H. Gilbert Welch, William C. Black

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.

via Overdiagnosis in Cancer — Welch and Black, 10.1093/jnci/djq099 — JNCI Journal of the National Cancer Institute.

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  1. From the journal website:

    “JNCI is published twice monthly by Oxford University Press and is not affiliated with the United States National Cancer Institute.”

    Regarding Gilbert Welch’s article: The overwhelming amount of data now coming to light supporting the folly of aggressive cancer screening is going to create incredible pressures on academic medicine. Many academic centers have invested incredible amount of money into building cancer detection and treatment infrastructure. It may be they are forced to recognize their bad investments or continue to foist aggressive screening to pay for their investments, despite evidence suggesting patient harm.

    From the standpoint of surviving bad bets, it could not come at a worse time.




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