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Estimating Overdiagnosis in Cancer Screening Studies

评估癌症筛查研究中的过度诊断

基本信息

批准号：
9267345
负责人：
RUTH D ETZIONI
金额：
$ 61.4万
依托单位：
FRED HUTCHINSON CANCER RESEARCH CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-05-01 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9267345
关键词：
Age Biological Markers Breast Cancer Detection Breast Cancer Model Breast Cancer Surveillance Consortium Characteristics Clinical Collection Comorbidity Complement Conflict (Psychology)Confusion Consensus Consultations Data Decision Making Detection Development Diagnosis Disease Disease Progression Elderly Equilibrium Foundations Frequencies Guidelines In Situ Incidence Knowledge Lesion Life Expectancy Malignant Neoplasms Malignant neoplasm of prostate Measures Medical Methods Modeling Morbidity - disease rate Natural History Patients Policies Policy Developments Policy Maker Population Price Primary Health Care Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Publishing Relative Risks Reporting Research Personnel Resources Risk Risk Estimate Screening for Prostate Cancer Screening for cancer Specific qualifier value Subgroup Symptoms Testing Uncertainty Woman Work age group base cancer risk cancer subtypes clinical Diagnosis clinical decision-making clinical risk disorder risk economic cost follow-up high risk improved individual patient malignant breast neoplasm men models and simulation older men older women pre-clinical programs public health relevance screening simulation sound tool tumor unnecessary treatment web site

项目摘要

DESCRIPTION (provided by applicant): Project Summary/Abstract Millions of US men and women undergo screening for early cancer detection every year. Overdiagnosis, or the detection by screening of cases that would never become clinically diagnosed, is now recognized as the greatest potential harm of screening. This presents an especially difficult clinical dilemma in breast cancer, where screening detects many in-situ tumors, and in prostate cancer, where latent cases are highly prevalent in older age groups. Overdiagnosed cases cannot be helped by treatment and overtreatment of these cases carries a high price in terms of patient morbidity and economic costs. Knowledge about overdiagnosis is critical for well-formed screening policies and for well-informed patient decision making. However, overdiagnosis depends on screening practices and personal factors and many published studies are biased or do not apply to populations that differ from those used for estimation. The objective of this work is to advance knowledge about how to validly estimate overdiagnosis and to provide concrete information about overdiagnosis associated with specific cancer screening settings so as to inform screening policy development and clinical decision making. In our first aim we will conduct a simulation study to identify acceptable approaches and key characteristics of valid overdiagnosis studies. Lessons from this aim will be applied in our second aim, which will adapt established population models to estimate overdiagnosis rates associated with breast and prostate cancer screening under different screening policies and for different population subgroups defined by patient and tumor characteristics. These estimates will be made available to policy makers and clinicians via our third aim, which will develop online calculators to present relevant and useful information about overdiagnosis to these groups. Our study team of statisticians, breast and prostate cancer modelers and clinicians includes experts in simulation modeling, prominent clinical researchers and leaders in policy development for breast and prostate cancer screening. This work will move the field forward to a point of greater consensus about how to estimate overdiagnosis and what to tell policy makers and clinicians who have been tasked with shared and informed decision making. The knowledge generated by this application will lead to sound screening policies and better- informed clinical decisions and should provide a valuable quantitative tool in the ongoing battle to improve the balance of benefit and harm associated with cancer screening.