Discrepancies and overdiagnosis in breast cancer organized screening. A "methodology" systematic review

Abstract

The risk-benefit ratio of breast cancer organized screening is the focus of much scientific controversy, especially about overdiagnosis. The aim of this study was to relate methodological discrepancies to variations in rates of overdiagnosis to help build future decision aids and to better communicate with patients. A systematic review of methodology was conducted by two investigators who searched Medline and Cochrane databases from 01/01/2004to 12/31/2016. Results were restricted to randomized controlled trials (RCTs) and observational studies in French or English that examined the question of the overdiagnosis computation. Twenty-three observational studies and four RCTs were analyzed. The methods used comparisons of annual or cumulative incidence rates (age-cohort model) in populations invited to screen versus non-invited populations. Lead time and ductal carcinoma in situ (DCIS) were often taken into account. Some studies used statistical modeling based on the natural history of breast cancer and gradual screening implementation. Adjustments for lead time lowered the rate of overdiagnosis. Rate discrepancies, ranging from 1to 15% for some authors and around 30% for others, could be explained by the hypotheses accepted concerning very slow growing tumors or tumors that regress spontaneously. Apparently, research has to be centered on the natural history of breast cancer in order to provide responses concerning the questions raised by the overdiagnosis controversy.