Impact of overdiagnosis on long-term breast cancer survival

Jean Ching Yuan Fann, King Jen Chang, Chen Yang Hsu, Amy Ming Fang Yen, Cheng Ping Yu, Sam Li Sheng Chen, Wen Hung Kuo, László Tabár, Hsiu Hsi Chen

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Elucidating whether and how long-term survival of breast cancer is mainly due to cure after early detection and effective treatment and therapy or overdiagnosis resulting from the widespread use of mammography provides a new insight into the role mammography plays in screening, surveillance, and treatment of breast cancer. Given information on detection modes, the impact of overdiagnosis due to mammography screening on long-term breast cancer survival was quantitatively assessed by applying a zero (cured or overdiagnosis)-inflated model design and analysis to a 15-year follow-up breast cancer cohort in Dalarna, Sweden. The probability for non-progressive breast cancer (the zero part) was 56.14% including the 44.34% complete cure after early detection and initial treatment and a small 11.80% overdiagnosis resulting from mammography screening program (8.94%) and high awareness (2.86%). The 15-year adjusted cumulative survival of breast cancer was dropped from 88.25% to 74.80% after correcting for the zero-inflated part of overdiagnosis. The present findings reveal that the majority of survivors among women diagnosed with breast cancer could be attributed to the cure resulting from mammography screening and accompanying effective treatment and therapy and only a small fraction of those were due to overdiagnosis.

Original languageEnglish
Article number325
Issue number3
Publication statusPublished - Mar 1 2019


  • Invasive breast cancer
  • Mammography screening
  • Overdiagnosis
  • Zero-inflated Poisson regression model

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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