In his recent article, “Screening Mammography: Update and Review of Publications Since
Our Report in the New England Journal of Medicine on the Magnitude of the Problem
in the United States,” Dr. Archie Bleyer attempts to amass data from multiple studies
to strengthen his case for the clinical relevance of the concept of overdiagnosis
of breast cancers detected by screening mammography. In doing so, he illustrates one
of the fundamental problems with the topic. Because there are no studies that directly
measure the existence, extent, and effect of overdiagnosis of breast cancer, one is
left with widely disparate estimates of “overdiagnosed” breast cancers (0–70%). This
disparity occurs because all of the information on overdiagnosis is simply an estimate—at
best, a projection based on rigorous calculation and extrapolation from existing data
(including randomized controlled trials and cancer registries), and at worst, only
a “best guess,” to use Bleyer's verbiage.
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References
- Effect of three decades of screening mammography on breast-cancer incidence.N Engl J Med. 2012; 367: 1998-2005
- Reduction in late-stage breast cancer incidence in the mammography era: implications for overdiagnosis of invasive cancer.Cancer. 2014; 120: 2649-2656
Article info
Publication history
Published online: October 23, 2015
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© 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
