David Yankelevitz, MD, Responds to Overdiagnosis Claims

Dec 9 2013

In a December 9, 2013, article published online by JAMA, researchers concluded that 18% of lung cancers found by the National Lung Cancer Screening Trial (NLST) via low-dose CT screening would not have progressed and posed a threat to the patient’s health.

Finding these sorts of cancers is commonly referred to as ‘overdiagnosis’. Overdiagnosis in cancer screening is a concern because it can lead to anxiety and further treatment that is not actually needed.

David Yankelevitz, MD, Professor of Radiology and Director of the Lung Biopsy Service, The Mount Sinai Hospital, responds as follows:

“The paper addresses the very important topic of ‘overdiagnosis’ of those cancers that would not have progressed had they not been treated, the implication being that people underwent unnecessary treatments.  It also offers some insights into which subtype of lung cancer this most frequently occurs.  

While the authors present the frequency at 18%, it should be stressed that they note this was an upper limit resulting from limitations in the data they had available, and there are other reasons as well, such as making the distinction as to whether the cancer was found on the first round or during subsequent rounds, where the rates are very different.  

More importantly, they also provide supportive evidence that the extent of overdiagnosis in the context of a well-defined lifetime screening program would actually be in the range of 3%. As noted by the authors, it is important to stress potential risks and benefits to people interested in screening --  which we do routinely at Mount Sinai -- but this should focus on clinically meaningful estimates and not on upper limits.”

The decision to participate in lung cancer screening is an important one, especially for high-risk patients. Each individual must carefully consider the benefits and potential risks, and discuss these with their physician. To learn more, browse our Learning Library or contact a screening site near you.
This article references the following publication:

Title: Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer
Journal: JAMA Internal Medicine
DOI: 10.1001/jamainternmed.2013.12738
Found online at: http://archinte.jamanetwork.com/article.aspx?articleid=1785197