Estimating the magnitude of cancer overdiagnosis in Australia

Glasziou, Paul; Jones, Mark; Pathirana, Thanya; Barratt, Alexandra; Bell, Katy J.L.

doi:10.5694/mja2.50455

Cited by 109 publications

(112 citation statements)

References 33 publications

(49 reference statements)

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“…There are also major public health implications, especially given the magnitude of breast cancer over-diagnosis associated with mammographic screening [36]. It is interesting to reflect on Wolfe being an advocate of early mammographic screening.…”

Section: Discussionmentioning

confidence: 99%

Going Beyond Conventional Mammographic Density to Discover Novel Mammogram-Based Predictors of Breast Cancer Risk

Hopper

Nguyen

Schmidt

et al. 2020

JCM

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This commentary is about predicting a woman’s breast cancer risk from her mammogram, building on the work of Wolfe, Boyd and Yaffe on mammographic density. We summarise our efforts at finding new mammogram-based risk predictors, and how they combine with the conventional mammographic density, in predicting risk for interval cancers and screen-detected breast cancers across different ages at diagnosis and for both Caucasian and Asian women. Using the OPERA (odds ratio per adjusted standard deviation) concept, in which the risk gradient is measured on an appropriate scale that takes into account other factors adjusted for by design or analysis, we show that our new mammogram-based measures are the strongest of all currently known breast cancer risk factors in terms of risk discrimination on a population-basis. We summarise our findings graphically using a path diagram in which conventional mammographic density predicts interval cancer due to its role in masking, while the new mammogram-based risk measures could have a causal effect on both interval and screen-detected breast cancer. We discuss attempts by others to pursue this line of investigation, the measurement challenge that allows different measures to be compared in an open and transparent manner on the same datasets, as well as the biological and public health consequences.

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Section: Discussionmentioning

confidence: 99%

Going Beyond Conventional Mammographic Density to Discover Novel Mammogram-Based Predictors of Breast Cancer Risk

Hopper

Nguyen

Schmidt

et al. 2020

JCM

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“…This may have increased incidence statistics in these locations. Indeed, potential over-diagnosis has been mooted [103].…”

Section: Discussionmentioning

confidence: 99%

Evolved adaptation to low ultraviolet radiation may be the main cause of malignant melanoma independent of high ultraviolet radiation levels

You

Henneberg

Coventry

et al. 2020

Preprint

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Abstract Background: The low melanin production (depigmentation) evolved in response to low ultraviolet radiation may be the principal determinant of malignant melanoma of skin (C43). Methods: Worldwide country-speciﬁc estimates of melanoma incidence, daily UVR levels, skin colour (EEL), socioeconomic status (GDP PPP), magnitude of reduced natural selection (Ibs), ageing, urbanization, percentage of European descendants (Eu%), and depigmentation measured by blonde hair colour, were subjected to statistical analyses. Data for 182 individual countries were derived from WHO, United Nations, World Bank databases and the literature. Parametric and non-parametric correlations, partial correlation analyses keeping confounders statistically constant, multivariate regressions and analyses of variance were used. Results: Worldwide, UVR levels were in negative correlation with melanoma (C43) incidence (“rho” = -0.515, p<0.001). This relationship remained significant and negative in parametric partial correlation (r = -0.513, p<0.001) when GDP PPP, Ibs, ageing and urbanization were statistically kept constant. In stepwise linear regression analysis, UVR was the variable having greatest negative influence on melanoma incidence (R2=0.301). Melanoma incidence was in strong correlation with Eu% (r = 0.711, p<0.001). The negative relationship between melanoma and UVR levels (r = -0.498, r<0.001) and positive relationship of melanoma with Eu% (r = 0.477, p<0.001) remained significant in partial correlation analyses.When melanoma incidence rate was standardised on Eu% it did not correlate at all with UVR (“rho”=0.004, p=0.967, n=127). The country-specific depigmentation level strongly correlated with melanoma incidence (r = 0.705, p<0.001, n= 48) remaining significant in partial correlation (r=0.315, p<0.01). However, UVR showed nil no correlation with melanoma when depigmentation, together with the other four potential confounders was included as the controlled variable. Conclusions: Low melanin production, genetically determined, that has adaptively evolved over generations represents the principal risk factor for melanoma, while UVR has a secondary role.

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“…On the contrary, fast-growing cancers producing symptoms are more likely to prompt a patient to contact a doctor any time ( 31 ). It has been estimated that about 11,000 cancers in women and 18,000 cancers in men are overdiagnosed in Australia each year ( 49 ). Interestingly, the screening program introduced in Fukushima after the nuclear plant accident showed thyroid cancer incidence 30 times higher than the national incidence in children and adolescents both in contaminated and non-contaminated regions ( 13 ).…”

Section: Is Overdiagnosis the Main Reason Of A Growing Incidence Of Lmentioning

confidence: 99%

“…It is of particular relevance in some malignancies, showing a growing incidence. Early detection does not result in any improvement of their curability, like in non-invasive breast, thyroid, and prostate carcinoma ( 49 ), leading to overdiagnosis. Patients overdiagnosed with thyroid cancer are harmed by the psycho-social aspect of cancer diagnosis, treatment applied, and treatment-related consequences.…”

Section: Quality Of Life Psychological and Economic Considerationsmentioning

confidence: 99%

Early Diagnosis of Low-Risk Papillary Thyroid Cancer Results Rather in Overtreatment Than a Better Survival

et al. 2020

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We are witnessing a rapid worldwide increase in the incidence of papillary thyroid carcinoma (PTC) in the last thirty years. Extensive implementation of cancer screening and wide availability of neck ultrasound or other imaging studies is the main reason responsible for this phenomenon. It resulted in a detection of a growing number of clinically asymptomatic PTCs, mainly low-risk tumors, without any beneficial impact on survival. An indolent nature of low-risk PTC, particularly papillary thyroid microcarcinoma (PTMC), and the excellent outcomes raise an ongoing discussion regarding the adequacy of treatment applied. The question of whether PTMC is overtreated or not is currently completed by another, whether PTMC requires any treatment. Current ATA guidelines propose less extensive preoperative diagnostics and, if differentiated thyroid cancer is diagnosed, less aggressive surgical approach and limit indications for postoperative radioiodine therapy. However, in intrathyroidal PTMCs in the absence of lymph node or distant metastases, active surveillance may constitute alternative management with a low progression rate of 1%–5% and without any increase in the risk of poorer outcomes related to delayed surgery in patients, in whom it was necessary. This review summarizes the current knowledge and future perspectives of active surveillance in low-risk PTC.

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Estimating the magnitude of cancer overdiagnosis in Australia

Cited by 109 publications

References 33 publications

Going Beyond Conventional Mammographic Density to Discover Novel Mammogram-Based Predictors of Breast Cancer Risk

Going Beyond Conventional Mammographic Density to Discover Novel Mammogram-Based Predictors of Breast Cancer Risk

Evolved adaptation to low ultraviolet radiation may be the main cause of malignant melanoma independent of high ultraviolet radiation levels

Early Diagnosis of Low-Risk Papillary Thyroid Cancer Results Rather in Overtreatment Than a Better Survival

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