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BMJ Open. 2019 Mar 10;9(3):e022457. doi: 10.1136/bmjopen-2018-022457.

Lifetime risk of prostate cancer overdiagnosis in Australia: quantifying the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach.

Author information

1
Center for Research in Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
2
School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia.
3
Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
4
School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

Abstract

OBJECTIVES:

To quantify the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach.

DESIGN:

Modelling and validation of the lifetime risk method using publicly available population data.

SETTING:

Opportunistic screening for prostate cancer in the Australian population.

PARTICIPANTS:

Australian male population (1982-2012).

INTERVENTIONS:

Prostate-specific antigen testing for prostate cancer screening.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Primary: lifetime risk of overdiagnosis in 2012 (excess lifetime cancer risk adjusted for changing competing mortality); Secondary: lifetime risk of prostate cancer diagnosis (unadjusted and adjusted for competing mortality); Excess lifetime risk of prostate cancer diagnosis (for all years subsequent to 1982).

RESULTS:

The lifetime risk of being diagnosed with prostate cancer increased from 6.1% in 1982 (1 in 17) to 19.6% in 2012 (1 in 5). Using 2012 competing mortality rates, the lifetime risk in 1982 was 11.5% (95% CI 11.0% to 12.0%). The excess lifetime risk of prostate cancer in 2012 (adjusted for changing competing mortality) was 8.2% (95% CI 7.6% to 8.7%) (1 in 13). This corresponds to 41% of prostate cancers being overdiagnosed.

CONCLUSIONS:

Our estimated rate of overdiagnosis is in agreement with estimates using other methods. This method may be used without the need to adjust for lead times. If annual (cross-sectional) data are used, then it may give valid estimates of overdiagnosis once screening has been established long enough for the benefits from the early detection of non-overdiagnosed cancer at a younger age to be realised in older age groups.

KEYWORDS:

cancer overdiagnosis; lifetime risk; prostate cancer

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