Overdiagnosis: epidemiologic concepts and estimation.
Ontology highlight
ABSTRACT:
SUBMITTER: Bae JM
PROVIDER: S-EPMC4398975 | biostudies-literature | 2015
REPOSITORIES: biostudies-literature
Publications
Overdiagnosis: epidemiologic concepts and estimation.
Epidemiology and health 20150210
Overdiagnosis of thyroid cancer was propounded regarding the rapidly increasing incidence in South Korea. Overdiagnosis is defined as 'the detection of cancers that would never have been found were it not for the screening test', and may be an extreme form of lead bias due to indolent cancers, as is inevitable when conducting a cancer screening programme. Because it is solely an epidemiological concept, it can be estimated indirectly by phenomena such as a lack of compensatory drop in post-scree ...[more]
Similar Datasets
Project description:The primary cause of the increase in melanoma incidence in the United States has been suggested to be overdiagnosis. We used Surveillance, Epidemiology, and End Result Program data from 1975 to 2017 to examine epidemiologic trends of melanoma incidence and mortality and better characterize overdiagnosis in white Americans. Over the 43-year period, incidence and mortality showed discordant temporal changes across population subgroups; trends most suggestive of overdiagnosis alone were present in females aged 55-74. Other groups showed mixed changes suggestive of overdiagnosis plus changes in underlying disease risk (decreasing risk in younger individuals and increasing risk in older males). Cohort effects were identified for male and female mortality and male incidence but were not as apparent for female incidence, suggesting that period effects have had a greater influence on changes in incidence over time in females. Encouraging trends included long-term declines in mortality in younger individuals and recent stabilization of invasive incidence in individuals aged 15-44 years and males aged 45-54 years. Melanoma in situ incidence, however, has continued to increase throughout the population. Overdiagnosis appears to be relatively greater in American females and for melanoma in situ.
| S-EPMC9187775 | biostudies-literature
Project description:BackgroundMammography screening can lead to overdiagnosis-that is, screen-detected breast cancer that would not have caused symptoms or signs in the remaining lifetime. There is no consensus about the frequency of breast cancer overdiagnosis.ObjectiveTo estimate the rate of breast cancer overdiagnosis in contemporary mammography practice accounting for the detection of nonprogressive cancer.DesignBayesian inference of the natural history of breast cancer using individual screening and diagnosis records, allowing for nonprogressive preclinical cancer. Combination of fitted natural history model with life-table data to predict the rate of overdiagnosis among screen-detected cancer under biennial screening.SettingBreast Cancer Surveillance Consortium (BCSC) facilities.ParticipantsWomen aged 50 to 74 years at first mammography screen between 2000 and 2018.MeasurementsScreening mammograms and screen-detected or interval breast cancer.ResultsThe cohort included 35 986 women, 82 677 mammograms, and 718 breast cancer diagnoses. Among all preclinical cancer cases, 4.5% (95% uncertainty interval [UI], 0.1% to 14.8%) were estimated to be nonprogressive. In a program of biennial screening from age 50 to 74 years, 15.4% (UI, 9.4% to 26.5%) of screen-detected cancer cases were estimated to be overdiagnosed, with 6.1% (UI, 0.2% to 20.1%) due to detecting indolent preclinical cancer and 9.3% (UI, 5.5% to 13.5%) due to detecting progressive preclinical cancer in women who would have died of an unrelated cause before clinical diagnosis.LimitationsExclusion of women with first mammography screen outside BCSC.ConclusionOn the basis of an authoritative U.S. population data set, the analysis projected that among biennially screened women aged 50 to 74 years, about 1 in 7 cases of screen-detected cancer is overdiagnosed. This information clarifies the risk for breast cancer overdiagnosis in contemporary screening practice and should facilitate shared and informed decision making about mammography screening.Primary funding sourceNational Cancer Institute.
| S-EPMC9359467 | biostudies-literature
Project description:In the design of intervention and observational epidemiological studies sample size calculations are used to provide estimates of the minimum number of observations that need to be made to ensure that the stated objectives of a study are met. Justification of the number of subjects enrolled into a study and details of the assumptions and methodologies used to derive sample size estimates are now a mandatory component of grant application processes by funding agencies. Studies with insufficient numbers of study subjects run the risk of failing to identify differences among treatment or exposure groups when differences do, in fact, exist. Selection of a number of study subjects greater than that actually required results in a wastage of time and resources. In contrast to human epidemiological research, individual study subjects in a veterinary setting are almost always aggregated into hierarchical groups and, for this reason, sample size estimates calculated using formulae that assume data independence are not appropriate. This paper provides an overview of the reasons researchers might need to calculate an appropriate sample size in veterinary epidemiology and a summary of sample size calculation methods. Two approaches are presented for dealing with lack of data independence when calculating sample sizes: (1) inflation of crude sample size estimates using a design effect; and (2) simulation-based methods. The advantage of simulation methods is that appropriate sample sizes can be estimated for complex study designs for which formula-based methods are not available. A description of the methodological approach for simulation is described and a worked example provided.
| S-EPMC7925405 | biostudies-literature
Project description:High-quality prevalence and incidence studies of oral conditions are essential for estimation of disease burden and comparison of estimates among countries and over time, as well as for priority setting, resource allocation, and planning public health action. Existing systematic reviews of the epidemiology of untreated dental caries, severe periodontitis, and edentulism, carried out for the Global Burden of Disease study, showed inadequate and incomplete reporting of the measurement of oral conditions as well as a lack of consistency and comparability with other health conditions. These issues are more accentuated in studies from low- and middle-income countries. Studies must meet the highest standards so that these efforts do not waste resources. This report extends the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to improve and standardize the reporting of descriptive oral epidemiologic studies of common oral conditions. The aim of the Guidelines for Reporting Oral Epidemiologic Studies to Inform Burden Estimation (GROESBE) is to promote transparency, clarity, and comparability of scientific reporting, specifically for prevalence and incidence studies of untreated caries, severe periodontitis, and edentulism. The GROESBE guidelines and checklist were developed following a structured and formal consultation process with a geographically diverse group of 23 individuals involved in the conduct and analysis of oral epidemiologic studies. GROESBE focuses on elements that are not included in STROBE, adding 14 specific recommendations to existing guidelines. They will facilitate reliable comparison of emerging prevalence and incidence data on untreated caries, severe periodontitis, and edentulism across settings worldwide and the synthesis of robust evidence to inform estimation of disease burden in future iterations of the Global Burden of Disease study.
| S-EPMC11752649 | biostudies-literature
Project description:Overdiagnosis is a growing health issue, yet our understanding of medical students' exposure to this concept within medical education is limited. Our aim was to explore students' experience of diagnostic learning to identify how overdiagnosis may be understood by students. During in-person and online semi-structured interviews throughout 2021, we explored the education experience of twelve Western Sydney University medical students in years 3-5. Through inductive thematic analysis we identified four themes. These themes encompassed student commitment to learning about diagnosis, lack of certainty surrounding diagnosis and emotional factors of medical care, overdiagnosis as seen through the lens of high and low-value care during clinical placements and student-identified missed learning opportunities related to overdiagnosis. This study found that medical students develop inherent knowledge of overdiagnosis through an interplay of personal factors, medical school curriculum and the setting in which their training takes place. Our findings allow insight for future improvement of medical curriculum to produce exceptional medical graduates.
| S-EPMC10921797 | biostudies-literature
Project description:The problem of attitude estimation is broadly addressed using the Kalman filter formalism and unit quaternions to represent attitudes. This paper is also included in this framework, but introduces a new viewpoint from which the notions of "multiplicative update" and "covariance correction step" are conceived in a natural way. Concepts from manifold theory are used to define the moments of a distribution in a manifold. In particular, the mean and the covariance matrix of a distribution of unit quaternions are defined. Non-linear versions of the Kalman filter are developed applying these definitions. A simulation is designed to test the accuracy of the developed algorithms. The results of the simulation are analyzed and the best attitude estimator is selected according to the adopted performance metric.
| S-EPMC6339217 | biostudies-literature
Project description:ObjectiveTo estimate overdiagnosis of colorectal cancer (CRC) for screening with sigmoidoscopy and faecal occult blood testing (FOBT).DesignSimulation study using data from randomised trials.SettingPrimary screening, UK, Norway PARTICIPANTS: 152 850 individuals from the Nottingham trial and 98 678 individuals from the Norwegian Colorectal Cancer Prevention (NORCCAP) trial.InterventionCRC screening.Outcome measureWe estimated overdiagnosis using long-term data from two randomised trials: the Nottingham trial comparing FOBT screening every other year to no-screening, and the NORCCAP trial comparing once-only sigmoidoscopy screening to no-screening. To estimate the natural growth of adenomas to CRC, we used the following microsimulation models: (i) the Microsimulation Screening Analysis; (ii) the CRC Simulated Population model for Incidence and Natural history; (iii) the Simulation Model of Colorectal Cancer; (iv) a model derived by the German Cancer Research Center. We defined overdiagnosed cancers as the difference between the observed number of CRCs in the no-screening arm and the expected number of cancers in screening arm (sum of observed and prevented by adenoma removal). The amount of overdiagnosis is defined as the number of overdiagnosed cancers over the number of cancers observed in the no-screening arm.ResultsOverdiagnosis estimates were highly dependent on model assumptions. For FOBT screening with 2354 cancers observed in control arm, four out of five models predicted overdiagnosis, range 2.0% (2400 cancers expected in screening) to 7.6% (2533 cancers expected in screening). For sigmoidoscopy screening with 452 cancers observed in control arm, all models predicted overdiagnosis, range 25.2% (566 cancers expected in screening) to 128.1% (1031 cancers expected in screening).ConclusionsThe amount of overdiagnosis estimated based on the microsimulation models varied substantially. Microsimulation models may not give reliable estimates of the preventive effect of adenoma removal, and should be used with caution to inform guidelines.
| S-EPMC8054108 | biostudies-literature
Project description:Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI and CAP are also commonly overdiagnosed, resulting in unnecessary antibiotic use and diagnostic delays. While much is known individually about overdiagnosis of UTI and CAP, it is not known whether hospitals with higher overdiagnosis of one also have higher overdiagnosis of the other. Correlation of overdiagnosis of these two conditions may indicate underlying hospital-level contributors, which in turn may represent targets for intervention. To evaluate the association of overdiagnosis of UTI and CAP, we first determined the proportion of hospitalised patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then, we used Pearson's correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. Finally, we assessed for 'diagnostic momentum' (ie, accepting a previous diagnosis without sufficient scepticism) by determining how often overdiagnosed patients remained on antibiotics on day 3 of hospitalisation. We included 14 085 patients treated for CAP (11.4% were overdiagnosed) and 10 398 patients treated for UTI (27.8% were overdiagnosed) across 46 hospitals. Within hospitals, the proportion of patients overdiagnosed with UTI was moderately correlated with the proportion of patients overdiagnosed with CAP (r=0.53, p<0.001). Over 80% (81.8% (n=952/1164) of UTI; 89.9% (n=796/885) of CAP) of overdiagnosed patients started on antibiotics by an emergency medicine clinician remained on antibiotics on day 3 of hospitalisation. In conclusion, we found overdiagnosis of UTI and CAP to be correlated at the hospital level. Reducing overdiagnosis of these two common infections may benefit from systematic interventions.
| S-EPMC9121367 | biostudies-literature
Project description:This article presents a review of current practice in estimating steric sea level change, focussed on the treatment of uncertainty. Steric sea level change is the contribution to the change in sea level arising from the dependence of density on temperature and salinity. It is a significant component of sea level rise and a reflection of changing ocean heat content. However, tracking these steric changes still remains a significant challenge for the scientific community. We review the importance of understanding the uncertainty in estimates of steric sea level change. Relevant concepts of uncertainty are discussed and illustrated with the example of observational uncertainty propagation from a single profile of temperature and salinity measurements to steric height. We summarise and discuss the recent literature on methodologies and techniques used to estimate steric sea level in the context of the treatment of uncertainty. Our conclusions are that progress in quantifying steric sea level uncertainty will benefit from: greater clarity and transparency in published discussions of uncertainty, including exploitation of international standards for quantifying and expressing uncertainty in measurement; and the development of community "recipes" for quantifying the error covariances in observations and from sparse sampling and for estimating and propagating uncertainty across spatio-temporal scales.
| S-EPMC7115123 | biostudies-literature
Project description:There have been hundreds of publications about overdiagnosis during the past decade describing concern regarding its potential for harms in lung cancer screening. However, the definition and frequency with which it occurs in screening trials remains unclear. This lack of clarity stems from its current definition which is not based on a clinical grounds but instead on an epidemiologic definition that depends on the cause of death. Thus, with the current definition an overdiagnosed cancer can only be diagnosed if the person does not die from the cancer, regardless of whether or not the cancer is aggressive or the treatment successful. Using a definition based on epidemiology rather than the clinical presentation is highly unusual. Furthermore, the frequency of overdiagnosis has also been a cause of great confusion. Prior to the results from the National Lung Screening trial (NLST), concerns were expressed that virtually all CT screen detected cancers would be overdiagnosed, yet the extended follow-up study of the National Lung Screening Trial shows that in essence there were virtually no overdiagnosis. Even more confusing is that it was previously suspected that there was a high rate of overdiagnosis when using chest radiographic screening and therefore as CT is a more sensitive imaging test and finds cancers even earlier, it would be presumed that the overdiagnosis rate for CT would be even be higher. A proposed change in the definition would focus more on the clinical manifestation of the cancer as to its aggressiveness as this can be diagnosed while the patient is alive. Using a definition that is based on clinical features, a cancer that manifests as a nonsolid nodule would be considered overdiagnosed if instead of being recognized as relatively indolent was instead thought to be an aggressive cancer. The concept of overtreatment arises if this nonaggressive cancer were treated aggressively.
| S-EPMC7947395 | biostudies-literature