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It does not adjust for lead time, which tends to overestimate overdiagnosis.
It is also necessary to consider potential effects of lead time but to completely adjust for lead time bias is a challenging task.
Importantly, the authors failed to adjust for lead time, new prevalence cancers being added each year, or the increasing baseline incidence of breast cancer.
67 They label ecological and cohort studies that do not statistically adjust for lead time as the "excess incidence approach" of overdiagnosis estimation and argue that these studies may yield a biased estimate if the early years of screening dissemination are included.
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This could help adjust for lead-time bias, comparison between centers and management policies.
In studies based on statistical modeling to adjust for lead-time, estimates of overdiagnosis are consistently below 5% [ 42, 43].
The association between BC and global cognitive function was somewhat attenuated after we adjusted for lead in our multivariable-adjusted model (−0.038 per doubling in BC; 95% CI, −0.089 to 0.012).
We also adjusted for lead time bias.
Not adjusting for lead time would lead to overestimating overdiagnosis.
The overall 10-year survival of the screen-detected tumours adjusted for lead time was 79.8%.
When screen-detected tumour survival was additionally adjusted for lead time, the survival advantage was still evident, but smaller.
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