Increasing diagnosis of XXXX leads to spurious improvements in survival rates.

@entity5 @entity1 @entity259
BACKGROUND: Survival rates are commonly used to measure success in treating @entity5 , but can be misleading. Modern diagnostic practices can lead to the appearance of improving @entity5 survival, as @entity5 are diagnosed earlier (lead-time bias) or as an increasing proportion are slow-growing (length bias), whereas the actual burden of @entity5 deaths is unchanged. Increasingly, more @entity259 are being diagnosed. The objective of the current study was to determine whether @entity259 survival rates have been affected by this phenomenon. METHODS: The authors analyzed survival data from @entity1 with @entity259 who were treated at Memorial Sloan Kettering @entity5 Center (MSKCC) from 1950 to 2005, and United States population-based incidence, prevalence, and survival data from 1973 to 2009 in the Surveillance, Epidemiology, and End Results data set. RESULTS: US @entity259 incidence has increased 3-fold from 1975 to 2009. Over time, the proportion of @entity259 that are subcentimeter in size has increased from 23% (1983) to 36% (2009). At MSKCC, this percentage rose from 20% (1950) to 35% (2005). The incidence rates of large @entity5 (>6 cm) and distant metastasis have not changed. In the United States, 10-year relative survival improved from 95.4% to 98.6% (1983-1999). At MSKCC, 10-year disease-specific survival improved from 91.1% to 96.1% (1950-2005). However, when stratified by @entity5 size and stage, no changes in survival outcomes were observed. US @entity259 mortality rates have remained stable (1975-2009). CONCLUSIONS: Modern medical practices increasingly uncover small, asymptomatic @entity259 . Survival rates appear improved, but this finding is spurious, attributable instead to shifts in the characteristics of disease being diagnosed. Relying on survival rates to measure success in treating @entity259 may reinforce inappropriately aggressive management. Treatment decisions in @entity259 should be made based on mortality, not survival data. @entity5 2015.    2014 American @entity5 Society.
