A reality check for overdiagnosis estimates associated with breast cancer screening. J Natl Cancer Inst. 2014

The frequency of overdiagnosis associated with breast cancer screening is a topic of controversy. Published estimates vary widely, but identifying which estimates are reliable is challenging. In this article we present an approach that provides a check on these estimates. Our approach leverages the close link between overdiagnosis and lead time by identifying the average lead time most consistent with a given overdiag-nosis frequency. We consider a high-profile study that suggested that 31 % of breast cancers diagnosed in the United States in 2008 were overdiagnosed and show that this corresponds to an average lead time of about nine years among localized cases. Comparing this estimate with the average lead time for invasive, screen-detected breast cancers of 40 months, around which there is a relative consensus, suggests the published estimate of overdiagnosis is excessive. This approach provides a novel way to appraise estimates of overdiagnosis given knowledge of disease natural history. JNCI J Natl Cancer Inst (2014) 106(12): dju315 doi:10.1093/jnci/dju315 Overdiagnosis because of breast cancer screening is controversial, with estimates o