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Biostatistics 2004 5(4):603-613; doi:10.1093/biostatistics/kxh012
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Biostatistics Vol. 5 No. 4 © Oxford University Press 2004; all rights reserved.

Overdiagnosis in early detection programs

Ori Davidov{dagger}

Department of Statistics, University of Haifa, Mount Carmel, Haifa 31905, Israel
davidov{at}stat.haifa.ac.il

Marvin Zelen

Department of Biostatistics, Harvard University and the Dana Farber Cancer Institute, Boston MA 02115, USA
zelen{at}hsph.harvard.edu

{dagger} To whom correspondence should be addressed.

Overdiagnosis refers to the situation where a screening exam detects a disease that would have otherwise been undetected in a person's lifetime. The disease would have not have been diagnosed because the individual would have died of other causes prior to its clinical onset. Although the probability of overdiagnosis is an important quantity for understanding early detection programs it has not been rigorously studied. We analyze an idealized early detection program and derive the mathematical expression for the probability of overdiagnosis. The results are studied numerically for prostate cancer and applied to a variety of screening schedules. Our investigation indicates that the probability of overdiagnosis is remarkably high.

Keywords: Early detection programs; Overdiagnosis; Screening


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