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. 2020 Mar;212(4):163-168.
doi: 10.5694/mja2.50455. Epub 2019 Dec 19.

Estimating the magnitude of cancer overdiagnosis in Australia

Paul P Glasziou  1 , Mark A Jones  1 , Thanya Pathirana  2 , Alexandra L Barratt  3 , Katy Jl Bell  3
Affiliations

Estimating the magnitude of cancer overdiagnosis in Australia

Paul P Glasziou et al. Med J Aust. 2020 Mar.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Med J Aust. 2020 Apr;212(6):253. doi: 10.5694/mja2.50564. Epub 2020 Mar 17. Med J Aust. 2020. PMID: 32248540 Free PMC article. No abstract available.

Abstract

Objectives: To estimate the proportion of cancer diagnoses in Australia that might reasonably be attributed to overdiagnosis by comparing current and past lifetime risks of cancer.

Design, setting, and participants: Routinely collected Australian Institute of Health and Welfare national data were analysed to estimate recent (2012) and historical (1982) lifetime risks (adjusted for competing risk of death and changes in risk factors) of diagnoses with five cancers: prostate, breast, renal, thyroid cancers, and melanoma.

Main outcome measure: Difference in lifetime risks of cancer diagnosis between 1982 and 2012, interpreted as probable overdiagnosis.

Results: For women, absolute lifetime risk increased by 3.4 percentage points for breast cancer (invasive cancers, 1.7 percentage points), 0.6 percentage point for renal cancer, 1.0 percentage point for thyroid cancer, and 5.1 percentage points for melanoma (invasive melanoma, 0.7 percentage point). An estimated 22% of breast cancers (invasive cancers, 13%), 58% of renal cancers, 73% of thyroid cancers, and 54% of melanomas (invasive melanoma, 15%) were overdiagnosed, or 18% of all cancer diagnoses (8% of invasive cancer diagnoses). For men, absolute lifetime risk increased by 8.2 percentage points for prostate cancer, 0.8 percentage point for renal cancer, 0.4 percentage point for thyroid cancer, and 8.0 percentage points for melanoma (invasive melanoma, 1.5 percentage points). An estimated 42% of prostate cancers, 42% of renal cancers, 73% of thyroid cancers, and 58% of melanomas (invasive melanomas, 22%) were overdiagnosed, or 24% of all cancer diagnoses (16% of invasive cancer diagnoses). Alternative assumptions slightly modified the estimates for overdiagnosis of breast cancer and melanoma.

Conclusions: About 11 000 cancers in women and 18 000 in men may be overdiagnosed each year. Rates of overdiagnosis need to be reduced and health services should monitor emerging areas of overdiagnosis.

Keywords: Cancer; Early detection of cancer; Mass screening; Quality of health care.

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References

    1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424. - PubMed
    1. Australian Institute of Health and Welfare . Australia's health 2018 (Cat No. AUS 221; Australia's health series no. 16). Canberra: AIHW, 2018.
    1. Brodersen J, Schwartz LM, Heneghan C, et al. Overdiagnosis: what it is and what it isn't. BMJ Evid Based Med 2018; 23: 1–3. - PubMed
    1. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010; 102: 605–613. - PubMed
    1. Esserman LJ, Thompson IM, Reid B, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncology 2014; 15: E234–E242. - PMC - PubMed

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