ORCID Profile
0000-0003-2386-2183
Current Organisations
Bond University
,
Griffith University
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Publisher: Oxford University Press (OUP)
Date: 05-10-2023
Publisher: SAGE Publications
Date: 07-2022
DOI: 10.1177/23814683221129875
Abstract: Background. Overdiagnosis is an accepted harm of cancer screening, but studies of prostate cancer screening decision aids have not examined provision of information important in communicating the risk of overdiagnosis, including overdiagnosis frequency, competing mortality risk, and the high prevalence of indolent cancers in the population. Methods. We undertook a comprehensive review of all publicly available decision aids for prostate cancer screening, published in (or translated to) the English language, without date restrictions. We included all decision aids from a recent systematic review and screened excluded studies to identify further relevant decision aids. We used a Google search to identify further decision aids not published in peer reviewed medical literature. Two reviewers independently screened the decision aids and extracted information on communication of overdiagnosis. Disagreements were resolved through discussion or by consulting a third author. Results. Forty-one decision aids were included out of the 80 records identified through the search. Most decision aids ( n = 32, 79%) did not use the term overdiagnosis but included a description of it ( n = 38, 92%). Few ( n = 7, 17%) reported the frequency of overdiagnosis. Little more than half presented the benefits of prostate cancer screening before the harms ( n = 22, 54%) and only 16, (39%) presented information on competing risks of mortality. Only 2 ( n = 2, 5%) reported the prevalence of undiagnosed prostate cancer in the general population. Conclusion. Most patient decision aids for prostate cancer screening lacked important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis in decision aids, including appropriate content, terminology and graphical display. Most patient decision aids for prostate cancer screening lacks important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-022457
Abstract: To quantify the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach. Modelling and validation of the lifetime risk method using publicly available population data. Opportunistic screening for prostate cancer in the Australian population. Australian male population (1982–2012). Prostate-specific antigen testing for prostate cancer screening. 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). 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. 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.
Publisher: BMJ
Date: 12-08-2022
No related grants have been discovered for Thanya Pathirana.