Reducing the Burden of Overdiagnosis in Breast Cancer Screening and Beyond

EditorialsApril 2022Reducing the Burden of Overdiagnosis in Breast Cancer Screening and BeyondFelippe O. Marcondes, MD and Katrina Armstrong, MDFelippe O. Marcondes, MDDivision of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MassachusettsSearch for more papers by this author and Katrina Armstrong, MDDivision of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MassachusettsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-0483 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Nearly 60 years after the development of modern screening mammography, the issue of overdiagnosis from breast cancer screening remains controversial. This controversy is driven both by disciplinary differences in the definition of overdiagnosis and uncertainty about the probability of overdiagnosis. Ryser and colleagues' article offers an important step forward in addressing the latter concern (1). Using a natural history likelihood model based on data from the Breast Cancer Surveillance Consortium, the authors found that between 1 in 6 to 7 cases of cancer detected in a biennial screening program would not have manifested clinically in the woman's lifetime. These results ...References1. Ryser MD, Lange J, Inoue LYT, et al. Estimation of breast cancer overdiagnosis in a U.S. breast screening cohort. Ann Intern Med. 2022;175:471-8. doi:10.7326/M21-3577 LinkGoogle Scholar2. Nelson HD, O’Meara ES, Kerlikowske K, et al. Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data. Ann Intern Med. 2016;164:226-35. [PMID: 26756902] doi:10.7326/M15-0971 LinkGoogle Scholar3. Breen N, Yabroff KR, Meissner HI. What proportion of breast cancers are detected by mammography in the United States. Cancer Detect Prev. 2007;31:220-4. [PMID: 17573202] CrossrefMedlineGoogle Scholar4. Erbas B, Provenzano E, Armes J, et al. The natural history of ductal carcinoma in situ of the breast: a review. Breast Cancer Res Treat. 2006;97:135-44. [PMID: 16319971] CrossrefMedlineGoogle Scholar5. Loeb S, Bjurlin MA, Nicholson J, et al. Overdiagnosis and overtreatment of prostate cancer. Eur Urol. 2014;65:1046-55. [PMID: 24439788] doi:10.1016/j.eururo.2013.12.062 CrossrefMedlineGoogle Scholar6. Patz EF Jr. Lung cancer screening, overdiagnosis bias, and reevaluation of the Mayo Lung Project. J Natl Cancer Inst. 2006;98:724-5. [PMID: 16757691] CrossrefMedlineGoogle Scholar7. Castle PE, Glass AG, Rush BB, et al. Clinical human papillomavirus detection forecasts cervical cancer risk in women over 18 years of follow-up. J Clin Oncol. 2012;30:3044-50. [PMID: 22851570] doi:10.1200/JCO.2011.38.8389 CrossrefMedlineGoogle Scholar8. Jenniskens K, de Groot, Reitsma JB, et al. Overdiagnosis across medical disciplines: a scoping review. BMJ Open. 2017;7:e018448. [PMID: 29284720] doi:10.1136/bmjopen-2017-018448 CrossrefMedlineGoogle Scholar9. Davidson KW, Barry MJ, Mangione CM, et al; US Preventive Services Task Force. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. JAMA. 2021;326:736-743. [PMID: 34427594] doi:10.1001/jama.2021.12531 CrossrefMedlineGoogle Scholar10. Yudkin JS, Montori VM. The epidemic of pre-diabetes: the medicine and the politics. BMJ. 2014;349:g4485. [PMID: 25028385] doi:10.1136/bmj.g4485 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MassachusettsDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-0483.Corresponding Author: Katrina Armstrong, MD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail, [email protected]harvard.edu.This article was published at Annals.org on 1 March 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEstimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort Marc D. Ryser , Jane Lange , Lurdes Y.T. Inoue , Ellen S. O’Meara , Charlotte Gard , Diana L. Miglioretti , Jean-Luc Bulliard , Andrew F. Brouwer , E. Shelley Hwang , and Ruth B. Etzioni Metrics Cited byBreast cancer is overdiagnosed in one in six or seven cases, finds large US study April 2022Volume 175, Issue 4Page: 598-599KeywordsBreast cancerBreast cancer screeningCancer screeningHospital medicineMammographyOverdiagnosis ePublished: 1 March 2022 Issue Published: April 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...