NIH: Office of Disease Prevention

Medicine: Mind the Gap

3-Part Series on Disease Prevention Screening

Series Topic #3:
Overdiagnosis in Cancer Screening: Overcoming Challenges, Avoiding Mistakes

November 18, 2016
This Mind the Gap lecture was presented as a webinar.

Ruth B. Etzioni, Ph.D.

Ruth B. Etzioni, Ph.D. External Website Policy
Chair, Scientific Steering Committee
Hutch Data Commonwealth
Division of Public Health Sciences
Fred Hutchinson Cancer Research Center


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About the Seminar

The problem of overdiagnosis, the detection by screening of latent cancers that would never have surfaced, has been much in the news lately. What is overdiagnosis, and how significant is the problem? In this presentation, Dr. Etzioni examined how overdiagnosis arises and discussed what it takes to validly estimate its frequency. Different types of study designs and estimation methods have been used, but many of these probably yield biased results. Consumers of overdiagnosis studies need to carefully navigate the published literature to properly understand the extent of the problem. Dr. Etzioni provided a guide using examples from breast and prostate cancer screening to identify the types of studies that are most likely to produce reliable results.

About Ruth B. Etzioni, Ph.D.

Dr. Etzioni is a biostatistician and full member in the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center. Her research program focuses on the development of innovative statistical and computer models to learn about the latent process of cancer progression from observed data on disease incidence and mortality. This knowledge is applied to fill in the evidence gaps that inevitably arise when developing policies for cancer detection and management. A major component of her research concerns the development and evaluation of methods for estimation of overdiagnosis, which is an unobservable outcome of cancer screening. She was the first to quantify the frequency of overdiagnosis associated with prostate cancer screening in the United States and has published a number of studies examining overdiagnosis estimation in breast cancer. Dr. Etzioni’s models have been used to identify preferred policies for prostate cancer screening, project long-term comparative outcomes of active surveillance, determine how to tailor screening policies according to disease risk, and reconcile apparently conflicting trials of prostate cancer screening and treatment. She is a member of three national prostate cancer screening panels and co-authored the recently updated American Cancer Society’s recommendation on breast cancer screening. Dr. Etzioni leads the Cancer Intervention and Surveillance Modeling Network’s prostate cancer group and is a fellow of the American Statistical Association.

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