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Response to “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”

Published:October 23, 2015DOI:https://doi.org/10.1016/j.acra.2015.08.032
      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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        • Welch H.G.
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