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Comment & Response |

Estimating Overdiagnosis in Lung Cancer Screening

Brian D. Gelbman, MD1; Daniel M. Libby, MD1
[+] Author Affiliations
1Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, New York
JAMA Intern Med. 2014;174(7):1197-1198. doi:10.1001/jamainternmed.2014.1535.
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To the Editor Patz et al1 attempt to report on the rate of overdiagnosis that occurred as part of the National Lung Cancer Screening Trial (NLST), however their conclusion that “the probability is 18.5%…that any lung cancer detected by LDCT [low-dose computed tomography] was an overdiagnosis”1(p269) is very misleading.

In the introduction, the authors correctly assert that the excess rate of cancers detected during LDCT screening compared with chest radiography is attributable to either overdiagnosis or lead time. Lead time refers to cancers that will eventually be detected in the nonscreened arm after the screening period has ended. Lead time can be beneficial (and the purpose of screening) if the cancer detected would ultimately prove harmful to the individual, or it can simply reflect a bias of screening (lead-time bias) if the cancer would never become clinically meaningful. On the basis of the available NSLT data, it is impossible to distinguish between beneficial lead time and lead-time bias. However, it is possible to estimate that computed tomographic screening provides a consistent 1- to 2-year lead-time effect over chest radiography in the NSLT trial.2

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July 1, 2014
Edward F. Patz Jr, MD; Paul Pinsky, PhD; Barnett S. Kramer, MD
1Department of Radiology, Duke University Medical Center, Durham, North Carolina
2National Cancer Institute, Bethesda, Maryland
JAMA Intern Med. 2014;174(7):1198-1199. doi:10.1001/jamainternmed.2014.1525.
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