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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Lead-time models should not be used to estimate overdiagnosis in cancer screening

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  1. Chronic Diseases in High-Cost Users of Hospital, Primary Care, and Prescription Medication in the Capital Region of Denmark

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  2. Assessment of Residents Readiness to Perform Lumbar Puncture: A Validation Study

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  3. Low use and adherence to maintenance medication in chronic obstructive pulmonary disease in the general population

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  4. Improving efficiency of clinical skills training: a randomized trial

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  1. Hand cleaning with ash for reducing the spread of viral and bacterial infections: a rapid review

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  2. Is earlier better when it comes giving caffeine to preterm infants or are we risking unnecessary treatment and serious harm?

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  3. Continuing Antipsychotic Medication for Patients With Psychotic Depression in Remission

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  4. Cochrane Sustainable Healthcare: evidence for action on too much medicine

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  5. Do protocols for new randomised trials take previous similar trials into account? Cohort study of contemporary trial protocols

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Lead-time can mean two different things: Clinical lead-time is the lead-time for clinically relevant tumors; that is, those that are not overdiagnosed. Model-based lead-time is a theoretical construct where the time when the tumor would have caused symptoms is not limited by the person's death. It is the average time at which the diagnosis is brought forward for both clinically relevant and overdiagnosed cancers. When screening for breast cancer, clinical lead-time is about 1 year, while model-based lead-time varies from 2 to 7 years. There are two different methods to calculate overdiagnosis in cancer screening--the excess-incidence approach and the lead-time approach--that rely on two different lead-time definitions. Overdiagnosis when screening with mammography has varied from 0 to 75 %. We have explained that these differences are mainly caused by using different definitions and methods and not by variations in data. High levels of overdiagnosis of cancer have usually been explained by detection of many slow-growing tumors with long lead-times. This theory can be tested by studying if slow-growing tumors accumulate in the absence of screening, which they don't. Thus, it is likely that the natural history of many subclinical cancers is spontaneous regression.

Original languageEnglish
JournalJournal of General Internal Medicine
Volume29
Issue number9
Pages (from-to)1283-6
Number of pages4
ISSN0884-8734
DOIs
Publication statusPublished - Sep 2014

ID: 44633547