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. 2011 Nov 23:343:d7017.
doi: 10.1136/bmj.d7017.

Overdiagnosis from non-progressive cancer detected by screening mammography: stochastic simulation study with calibration to population based registry data

Arnaud Seigneurin  1 , Olivier François, José Labarère, Pierre Oudeville, Jean Monlong, Marc Colonna
Affiliations

Overdiagnosis from non-progressive cancer detected by screening mammography: stochastic simulation study with calibration to population based registry data

Arnaud Seigneurin et al. BMJ. .

Abstract

Objective: To quantify the magnitude of overdiagnosis from non-progressive disease detected by screening mammography, after adjustment for the potential for lead time bias, secular trend in the underlying risk of breast cancer, and opportunistic screening.

Design: Approximate bayesian computation analysis with a stochastic simulation model designed to replicate standardised incidence rates of breast cancer. The model components included the lifetime probability of breast cancer, the natural course of breast cancer, and participation in organised and opportunistic mammography screening.

Setting: Isère, a French administrative region with nearly 1.2 million inhabitants.

Participants: All women living in Isère and aged 50-69 during 1991-2006.

Main outcome measures: Overdiagnosis, defined as the proportion of non-progressive cancers among all cases of invasive cancer and carcinoma in situ detected 1991-2006.

Results: In 1991-2006, overdiagnosis from non-progressive disease accounted for 1.5% of all cases of invasive cancer (95% credibility interval 0.3% to 2.9%) and 28.0% of all cases of carcinoma in situ (2.2% to 59.8%) detected either clinically or by screening mammography in Isère. When analysis was restricted to the cancers detected by screening mammography only, the estimates of overdiagnosis were 3.3% (0.7% to 6.5%) and 31.9% (2.9% to 62.3%) for invasive cancer and carcinomas in situ, respectively.

Conclusion: Overdiagnosis from the detection of non-progressive disease by screening mammography was limited in 1991-2006 in Isère. Because carcinoma in situ accounted for less than 15% of all incident breast cancer cases, its contribution to overdiagnosis was relatively limited and imprecise.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Simulation model for each woman
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Fig 2 Mean predicted and observed standardised incidence rates of breast cancer among women aged 50-69, Isère, 1991-2006
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Fig 3 Posterior predictive distribution of overdiagnosis (%) among all cases of breast cancers detected either clinically or by screening mammography in women aged 50-69, Isère, 1991-2006
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Fig 4 Posterior predictive distribution of overdiagnosis (%) among all cases of breast cancers detected by screening mammography in women aged 50-69, Isère, 1991-2006
See this image and copyright information in PMC

Comment in

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