# Overdiagnosis in cancer Source: https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/ OnCo record `paper-welch-j-natl-cancer-inst` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence. ## TL;DR Paper cited by one bottleneck page and 21 idea pages, indexed on Europe PMC as PubMed record 20413742 and published in JNCI: Journal of the National Cancer Institute; the citing pages link this DOI, which is how the record was matched. ## Summary This article summarizes the phenomenon of cancer overdiagnosis-the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography-detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it. Indexed on Europe PMC as PubMed record 20413742 (DOI 10.1093/jnci/djq099). Matched by DOI alone: one bottleneck page and 21 idea pages cite this DOI among their external links (the pages are listed under Related), and this page was written so that the citation resolves inside OnCo. No figure has been checked by an editor. ## Fields - Kind: Key paper - Last checked: 2026-09-22 - Tags: europepmc-ingest - Journal: JNCI: Journal of the National Cancer Institute - Year: 2010 - DOI: 10.1093/jnci/djq099 - Authors: Welch HG, Black WC - What it means: One bottleneck page and 21 idea pages on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand. - Caveats: Matched to the citing OnCo records by DOI alone; the summary reproduces the Europe PMC abstract and no figure has been verified against the full paper. ## Sources - J Natl Cancer Inst 2010: https://doi.org/10.1093/jnci/djq099 - PubMed: https://pubmed.ncbi.nlm.nih.gov/20413742/ - Europe PMC: https://europepmc.org/article/MED/20413742 ## Connected records - bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/) - ideas: [A mandatory decision aid before any multi-cancer blood test](https://onco.cc/ideas/idea-prev-mced-pretest-decision-aid/), [A ten-year cohort of incidental findings to calibrate follow-up guidelines](https://onco.cc/ideas/idea-prev-incidentaloma-natural-history-cohort/), [A watch-and-wait registry for blood precursor conditions found by chance](https://onco.cc/ideas/idea-prev-blood-precursor-watch-registry/), [Active surveillance as the default for tiny papillary thyroid cancers](https://onco.cc/ideas/idea-prev-ptmc-active-surveillance-default/), [After the COMET trial: surveillance pathways and a new name for low-risk DCIS](https://onco.cc/ideas/idea-prev-low-risk-dcis-surveillance-pathway/), [AI malignancy scores to end repeat scans and biopsies for benign lung nodules](https://onco.cc/ideas/idea-prev-lung-nodule-ai-discharge/), [AI second reads to stop borderline lesions being upgraded to cancer](https://onco.cc/ideas/idea-prev-pathology-ai-borderline-anchor/), [An international body to rename indolent lesions so 'cancer' means something](https://onco.cc/ideas/idea-prev-indolent-lesion-nomenclature-body/), [Every screening programme must publish its overdiagnosis rate each year](https://onco.cc/ideas/idea-prev-annual-overdiagnosis-reporting/), [Hormone tablets instead of surgery for small breast cancers in the frail over-80s](https://onco.cc/ideas/idea-prev-frail-elderly-primary-endocrine-breast/), [Judge skin cancer AI by the thick melanomas it prevents, not the thin ones it finds](https://onco.cc/ideas/idea-prev-melanoma-ai-thick-melanoma-metric/), [Make skipping radiotherapy the default for very low-risk breast cancer](https://onco.cc/ideas/idea-prev-omit-radiotherapy-low-risk-breast-default/), [Modern autopsy studies to measure how much silent cancer people carry](https://onco.cc/ideas/idea-prev-modern-autopsy-reservoir-studies/), [Molecular indolence classifiers bundled with every screening programme](https://onco.cc/ideas/idea-moon-indolence-classifiers-with-screening/), [Prostate active surveillance without scheduled biopsies: MRI and blood tests decide](https://onco.cc/ideas/idea-prev-prostate-as-triggered-biopsy/), [Stop biopsying small thyroid nodules and never screen the thyroid](https://onco.cc/ideas/idea-prev-thyroid-no-screening-no-small-biopsy/), [Stop routine endoscopies for non-dysplastic Barrett's oesophagus](https://onco.cc/ideas/idea-prev-barrett-surveillance-deescalation/), [Stop screening by life expectancy, not birthday, with a tool in the record](https://onco.cc/ideas/idea-prev-screening-stop-by-life-expectancy/), [Stop watching stable low-risk pancreatic cysts after five years](https://onco.cc/ideas/idea-prev-ipmn-surveillance-stop-rule/), [Test whether calling Gleason 6 'not cancer' changes what men choose](https://onco.cc/ideas/idea-prev-gleason6-terminology-rct/), [Watch small kidney tumours rather than remove them, with a national registry](https://onco.cc/ideas/idea-prev-small-renal-mass-surveillance/) - journals: [JNCI: Journal of the National Cancer Institute](https://onco.cc/journals/jnci/) --- JSON: https://onco.cc/api/v1/entities/paper-welch-j-natl-cancer-inst.json