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Overdiagnosis in Lung Cancer Screening can be Reduced to a Low, Manageable Level via a Multilayered Strategy Involving Perfecting Reporting Systems, Restricting Screening to High-Risk Groups, Developing Better Risk Stratification Models, and Improving Management Algorithms

Published:October 27, 2015DOI:https://doi.org/10.1016/j.acra.2015.09.006
      That overdiagnosis exists in any type of cancer screening is not a point of contention, as I discussed in my article (
      • Mortani Barbosa Jr, E.J.
      Lung cancer screening overdiagnosis: reports of overdiagnosis in screening for lung cancer are grossly exaggerated.
      ). It is an inexorable consequence of our incomplete knowledge of the biological behavior of premalignant and malignant lesions and of the fundamental limitation that we cannot, by definition, predict random events. The relevant issues are how to estimate its magnitude and what solutions can be envisioned to reduce it. Measuring overdiagnosis is not a simple task, and clinical trial choices and assumptions dramatically influence its estimate (
      • Mortani Barbosa Jr, E.J.
      Lung cancer screening overdiagnosis: reports of overdiagnosis in screening for lung cancer are grossly exaggerated.
      ).
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