Influence of Study Features and Methods on Overdiagnosis Estimates in Breast and Prostate Cancer Screening

Ruth Etzioni, PhD; Roman Gulati, MS; Leslie Mallinger, MPH; and Jeanne Mandelblatt, MD, MPH

Source: Ann Intern Med. 2013;158(11):831-838. doi:10.7326/0003-4819-158-11-201306040-00008

Knowledge of the likelihood that a screening-detected case of cancer has been overdiagnosed is vitally important to make treatment decisions and develop screening policy. An overdiagnosed case is an excess case detected by screening. Estimates of the frequency of overdiagnosis in breast and prostate cancer screening vary greatly across studies. This article identifies features of overdiagnosis studies that influence results and shows their effect by using published research. First, different ways to define and measure overdiagnosis are considered. Second, contextual features and how they affect overdiagnosis estimates are examined. Third, the effect of estimation approach is discussed. Many studies use excess incidence under screening as a proxy for overdiagnosis. Others use statistical models to make inferences about lead time or natural history and then derive the corresponding fraction of cases that are overdiagnosed. This article concludes with questions that readers of overdiagnosis studies can use to evaluate the validity and relevance of published estimates and recommends that authors of studies quantifying overdiagnosis provide information about these features.

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Screening for prostate cancer

English: Prostate and bladder, sagittal section. 中文: 前列腺與膀胱，矢狀切面。 (Photo credit: Wikipedia)

Several places when you can find more about screening, in special for prostate cancer. We are going to attempt to share all this article in this post, and updating as new evidence's articles ( more and more every day ), and then you can decide for yourself.

Expanding the evidence on cancer screening: the value of scientific, social and ethical perspectives: Lucie Rychetnik, Stacy M Carter, Alexandra Barratt and Les Irwig. Med J Aust 2013; 198 (10): 536-539. doi: 10.5694/mja12.11275

United State American Task Force for Preventive Guidelines

Canadian Task Force on Preventive Health Care ( CTFPHC )

American Urological Association 

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New drugs for prostate cancer

Image via CrunchBase

By ANDREW POLLACK

Published: June 27, 2011

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A group of new drugs is promising to prolong the lives and relieve the symptoms of men with advanced prostate cancer, but could also add billions of dollars to the nation’s medical bills.

Bone-scan images before and after treatment with Cabozantinib. The dark spots are where cancer had spread to bones.

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Interactive Feature

Promising Treatments for Prostate Cancer Patients

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Jenny Mass

Mark Moldanado, a retired postal worker in Omaha, said that Jevtana had helped keep his cancer in check.

In the last 15 months, three new drugs that extended the lives of prostate cancer patients in clinical trials have been approved by the Food and Drug Administration and several other promising medicines are in clinical trials. Before last year, only one drug had been shown to improve survival — docetaxel, which was approved in 2004.

“What a great time it is in prostate cancer,” Dr. Daniel J. George of the Duke Cancer Institute proclaimed earlier this month at the annual meeting of the American Society of Clinical Oncology.

And it’s a great time for the drug makers, with several drugs competing to fill a niche for longer-term survival. Analysts estimate that some of the new drugs, particularly Dendreon’s Provenge and Johnson & Johnson’s Zytiga, could reach annual sales of $1 billion or even much more.

The recently approved drugs and most of those in development are for cases in which the disease has spread beyond the prostate gland and is no longer held in check by hormone therapy.

Men with that late-stage cancer had a median survival of about a year and a half using docetaxel. The new drugs each added two to five months to median survival when tested in clinical trials. Doctors say that men taking more than one of the drugs in succession would be expected to live more than two years.

But the price of these drugs has already stirred concerns about the costs of care among patients, providers and insurers. For example, Provenge costs $93,000 for a course of treatment, while Zytiga costs about $5,000 a month. Another of the new drugs, Sanofi’s Jevtana, costs about $8,000 every three weeks.

With other pricey drugs on the way, said Joel Sendek, an analyst at Lazard, “We could be talking easily $500,000 per patient or more over the course of therapy, which I don’t think the system can afford, especially since 80 percent of the patients are on Medicare.”