@article{227a52bf172d4aebb63ea0fd007af674,
title = "Impact of overdiagnosis on long-term breast cancer survival",
abstract = "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.",
keywords = "Invasive breast cancer, Mammography screening, Overdiagnosis, Zero-inflated Poisson regression model",
author = "Fann, {Jean Ching Yuan} and Chang, {King Jen} and Hsu, {Chen Yang} and Yen, {Amy Ming Fang} and Yu, {Cheng Ping} and Chen, {Sam Li Sheng} and Kuo, {Wen Hung} and L{\'a}szl{\'o} Tab{\'a}r and Chen, {Hsiu Hsi}",
note = "Funding Information: Acknowledgments: This work was financially supported by the “Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University” from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. Funding Information: Funding: Ministry of Science and Technology Grant; Ministry of Education Grant. H.H.C., A.M.F.Y., S.L.S.C., and C.Y.H. are supported by the Ministry of Science and Technology grant (grant number MOST 106-2118-M-002-006-MY2; MOST 106-2118-M-038-002-MY2; MOST 106-2811-M-002-075; MOST 107-3017-F-002-003). H.H.C. is supported by The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (NTU-107L9003). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2019 by the authors. Licensee MDPI, Basel, Switzerland.",
year = "2019",
month = mar,
day = "1",
doi = "10.3390/cancers11030325",
language = "English",
volume = "11",
journal = "Cancers",
issn = "2072-6694",
publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",
number = "3",
}