publication date: May. 3, 2019
Trials & Tribulations A comparison of study designs for estimating overdiagnosis in cancer screening
Barnett S. Kramer
Contractor, NCI Division of Cancer Control and Population Sciences, Office of the DCCPS Director
Former director of the NCI Division of Cancer Prevention
Philip C. Prorok
Contractor, NCI Division of Cancer Prevention, Office of the Director, Division of Cancer Prevention
Former chief of the Biometry Research Group at DCP
Overdiagnosis is defined as the diagnosis of an asymptomatic cancer that would not have become clinically evident during the person’s lifetime in the absence of screening or similar activities, such as diagnostic imaging tests that reveal “incidentalomas.”
The whole concept of overdiagnosis seems counterintuitive to the public and even to many clinicians, because the traditional view, encouraged by public health messages and by medical training, is that cancer is lethal unless detected early. This core belief system has driven the quest for increasingly sensitive screening tests that can detect as many asymptomatic cancers as possible.
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