Exploring Overdiagnosis in Cancer Screening

Lung cancer, CT scan
Lung cancer, CT scan
Standardized definition and guidance on estimation may facilitate understanding of cancer overdiagnosis.

HealthDay News — Recommendations for defining, estimating, and communicating overdiagnosis in cancer screening are discussed in a special article published online June 25 in the Annals of Internal Medicine.

Louise Davies, M.D., from White River Junction Veterans Affairs Medical Center in Vermont, and colleagues summarized the knowledge and provided guidance on defining, estimating, and communicating overdiagnosis in cancer screening.

The authors advocate defining overdiagnosis as the detection of a histologically confirmed cancer through screening that would not have been diagnosed in a person’s lifetime had screening not been carried out; this definition should also provide the numerator for estimates of the frequency of overdiagnosis. 

Where possible, the denominator for estimating overdiagnosis should be individuals who were screened (for patients) or individuals invited to screening (for program evaluation). Current data suggest that people remain highly interested in being screened despite recognizing that a detected cancer may be indolent, which is partly due to fear of cancer. To encourage decisions that are congruent with patients’ stated values, priorities, and risk tolerances, the target audience should be considered, messaging should be kept simple, attention should be paid to the wording relating to potential outcomes, and both benefits and harms of screening should be presented.

“To facilitate understanding of overdiagnosis in cancer screening, we have suggested a standardized definition and guidance on reporting estimates of overdiagnosis,” the authors write.

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