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.
- prostate cancer
- cancer overdiagnosis
- lifetime risk
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Contributors TP is a medical doctor completing her PhD on overdiagnosis of prostate cancer at Centre for Research in Evidence-based Practice (CREBP), Bond University, Australia and a senior lecturer in public health at School of Medicine, Griffith University, Australia. AH is a biostatistician and professor of public health, faculty of health, University of Technology Sydney. JD is a professor of clinical epidemiology in the Centre for Research in Evidence-Based Practice in Bond University and a general practitioner. PG is a professor of evidence-based medicine, the director of the Centre for Research in Evidence-Based Practice in Bond University and a general practitioner. KB is a senior lecturer in clinical epidemiology in the School of Public Health at the University of Sydney. KB conceived the ideas, developed them with all coauthors and edited the paper. TP retrieved data from Australian Institute of Health and Welfare, did the analyses, wrote the first draft, edited the paper and is guarantor. AH, JD and PG developed the ideas and edited the paper.
Funding The authors have received funding from the Australian National Health and Medical Research Council (NHMRC Fellowship No. 1080042, Centres of Research Excellence grant No. 1104136: Creating sustainable health care: ensuring new diagnostics avoid harms, improve outcomes and direct resources wisely and Program grant No. 1113532: Using healthcare wisely: reducing inappropriate use of tests and treatments).
Disclaimer The funders had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional data available on contacting corresponding author (TP) through email (email@example.com).
Patient consent for publication Not required.
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