{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:08:42Z","timestamp":1777928922150,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2017,11,19]],"date-time":"2017-11-19T00:00:00Z","timestamp":1511049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Med Screen"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Overdiagnosis is regarded as a harm of screening. We aimed to develop a non-homogeneous multi-state model to consider the age-specific transition rates for estimation of overdiagnosis, to validate the model by a simulation study where the true frequency of overdiagnosis can be calculated, and to compare our estimate with the cumulative incidence method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We constructed a four-state model to describe the natural history of breast cancer. The latent disease progression and the observed states for each individual were simulated in a trial with biennial screening of women aged 51\u201369 and a control group of the same size without screening. We performed 100 repetitions of the simulation with one million women to evaluate the performance of estimates. A sensitivity analysis with reduced number of controls was performed to imitate the data from the service screening programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on the 100 repetitions, the mean value of the true frequency of overdiagnosis was 12.5% and the average estimates by the cumulative incidence method and the multi-state model were 12.9% (interquartile range: 2.46%) and 13.4% (interquartile range: 2.16%), respectively. The multi-state model had a greater bias of overdiagnosis than the cumulative incidence method, but the variation in the estimates was smaller. When the number of unscreened group was reduced, the variation of multi-state model estimates increased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The multi-state model produces a proper estimate of overdiagnosis and the results are comparable with the cumulative incidence method. The multi-state model can be used in the estimation of overdiagnosis, and might be useful for the ongoing service screening programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0969141317733294","type":"journal-article","created":{"date-parts":[[2017,11,20]],"date-time":"2017-11-20T00:34:03Z","timestamp":1511138043000},"page":"183-190","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Estimation of overdiagnosis in breast cancer screening using a non-homogeneous multi-state model: A simulation study"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6169-5155","authenticated-orcid":false,"given":"Wendy Y-Y","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Radiation Sciences, Oncology, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennarth","family":"Nystr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e5kan","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Radiation Sciences, Oncology, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,11,19]]},"reference":[{"key":"bibr1-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61611-0"},{"key":"bibr2-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1258\/jms.2012.012077"},{"key":"bibr3-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1177\/096228029500400102"},{"key":"bibr4-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(07)70380-7"},{"key":"bibr5-0969141317733294","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-11-201306040-00008"},{"key":"bibr6-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1258\/jms.2012.012082"},{"key":"bibr7-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2016.04.015"},{"key":"bibr8-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1186\/bcr1354"},{"key":"bibr9-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1111\/j.1075-122X.2006.00272.x"},{"key":"bibr10-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(03)00260-0"},{"key":"bibr11-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1186\/bcr3365"},{"key":"bibr12-0969141317733294","unstructured":"National Board of Health and Welfare\u2019s Cancer Register, http:\/\/www.socialstyrelsen.se\/ (2015)."},{"key":"bibr13-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2015.08.013"},{"key":"bibr14-0969141317733294","doi-asserted-by":"crossref","unstructured":"Ripping TM, ten Haaf K, Verbeek AL, et\u00a0al. Quantifying overdiagnosis in cancer screening: a systematic review to evaluate the methodology.\n                      J Natl Cancer Inst\n                      2017; 109.","DOI":"10.1093\/jnci\/djx060"},{"key":"bibr15-0969141317733294","unstructured":"Cox DR, Miller HD. The theory of stochastic processesed, London, UK: Chapman & Hall, 1965, pp. 146\u2013202."},{"key":"bibr16-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602395"},{"key":"bibr17-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1093\/jncimono\/1997.22.93"},{"key":"bibr18-0969141317733294","first-page":"34","volume":"327","author":"Council of the European Union","year":"2003","journal-title":"Official Journal L"},{"key":"bibr19-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2011.05.012"},{"key":"bibr20-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.200310114"},{"key":"bibr21-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-009-0701-x"},{"key":"bibr22-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1985.10478195"},{"key":"bibr23-0969141317733294","doi-asserted-by":"crossref","unstructured":"Etzioni R and Gulati R. Recognizing the limitations of cancer overdiagnosis studies: a first step towards overcoming them.\n                      J Natl Cancer Inst\n                      2016; 108.","DOI":"10.1093\/jnci\/djv345"},{"key":"bibr24-0969141317733294","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.201000107"}],"container-title":["Journal of Medical Screening"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0969141317733294","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0969141317733294","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0969141317733294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:24:13Z","timestamp":1777677853000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0969141317733294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,19]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1177\/0969141317733294"],"URL":"https:\/\/doi.org\/10.1177\/0969141317733294","relation":{},"ISSN":["0969-1413","1475-5793"],"issn-type":[{"value":"0969-1413","type":"print"},{"value":"1475-5793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,19]]}}}