Evaluation of the overdiagnosis in breast screening programmes using a Monte Carlo simulation tool: a study of the influence of the parameters defining the programme configuration
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BMJ Open
Fecha
2019Referencia bibliográfica
Forastero C, Zamora LI, Guirado D, et al. Evaluation of the overdiagnosis in breast screening programmes using a Monte Carlo simulation tool: a study of the influence of the parameters defining the programme configuration. BMJ Open 2019;9:e023187.
Patrocinador
Work partially supported by the Biomedical Research Networking Center- CIBER de Epidemiología y Salud Pública (CIBERESP), the Spanish Ministerio de Ciencia y Competitividad (FPA2015-67694), the European Regional Development Fund (ERDF) and the Junta de Andalucía (FQM0387).Resumen
Objectives To build up and test a Monte Carlo simulation
procedure for the investigation of overdiagnosis in breast
screening programmes (BSPs).
Design A Monte Carlo tool previously developed has been
adapted for obtaining the quantities of interest in order to
determine the overdiagnosis: the annual and cumulative
number of cancers detected by screening, plus interval
cancers, for a population following the BSP, and detected
clinically for the same population in the absence of
screening. Overdiagnosis is obtained by comparing these
results in a direct way.
Results Overdiagnosis between 7% and 20%, depending
on the specific configuration of the programme, have been
found. These range of values is in agreement with some of
the results available for actual BSPs. In the cases analysed,
a reduction of 11% at most has been found in the number
of invasive tumours detected by screening in comparison
to those clinically detected in the control population. It has
been possible to establish that overdiagnosis is almost
entirely linked to ductal carcinoma in situ tumours.
Conclusions The use of Monte Carlo tools may facilitate
the analysis of overdiagnosis in actual BSPs, permitting to
address the role played by various quantities of relevance
for them.