Overdiagnosis in Breast Cancer Screening: Time to Tackle an Underappreciated Harm
Authors: Joann G. Elmore, Suzanne W. Fletcher
Journal: Annals of Internal Medicine (2012)

Editorials3 April 2012Overdiagnosis in Breast Cancer Screening: Time to Tackle an Underappreciated HarmJoann G. Elmore, MD, MPH and Suzanne W. Fletcher, MDJoann G. Elmore, MD, MPHFrom University of Washington School of Medicine, Seattle, WA 98104-2499, and Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215. and Suzanne W. Fletcher, MDFrom University of Washington School of Medicine, Seattle, WA 98104-2499, and Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-7-201204030-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The earlier that cancer is found, the better. This underlying tenet of cancer screening has saved many lives. However, studies are beginning to challenge the certainty that finding cancer early is always better. One stark example was the practice of screening infants for neuroblastoma. After the introduction of a simple urine test in Japan led to nationwide screening, the incidence of neuroblastoma approximately doubled, whereas that of mortality and late-stage disease remained unaffected. Widespread urine testing of infants was subsequently abandoned (1). The excess cases of cancer found on screening were examples of overdiagnosis, defined as occurring when "a condition ...References1. Sawada T. Past and future of neuroblastoma screening in Japan. Am J Pediatr Hematol Oncol. 1992;14:320-6. [PMID: 1456397] CrossrefMedlineGoogle Scholar2. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102:605-13. [PMID: 20413742] CrossrefMedlineGoogle Scholar3. Zackrisson S, Andersson I, Janzon L, Manjer J, Garne JP. Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ. 2006;332:689-92. [PMID: 16517548] CrossrefMedlineGoogle Scholar4. Duffy SW, Agbaje O, Tabar L, Vitak B, Bjurstam N, Björneld L, et al. Overdiagnosis and overtreatment of breast cancer: estimates of overdiagnosis from two trials of mammographic screening for breast cancer. Breast Cancer Res. 2005;7:258-65. [PMID: 16457701] CrossrefMedlineGoogle Scholar5. Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ. 2009;339:b2587. [PMID: 19589821] CrossrefMedlineGoogle Scholar6. Wu D, Pérez A. A limited review of over diagnosis methods and long term effects in breast cancer screening. Oncol Rev. 2011;5:143-147. [PMID: 21927651] CrossrefMedlineGoogle Scholar7. Biesheuvel C, Barratt A, Howard K, Houssami N, Irwig L. Effects of study methods and biases on estimates of invasive breast cancer overdetection with mammography screening: a systematic review. Lancet Oncol. 2007;8:1129-38. [PMID: 18054882] CrossrefMedlineGoogle Scholar8. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009;:CD001877. [PMID: 19821284] MedlineGoogle Scholar9. Kalager M, Adami HO, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program. Ann Intern Med. 2012;156:491-9. LinkGoogle Scholar10. Elmore JG, Nakano CY, Koepsell TD, Desnick LM, D'Orsi CJ, Ransohoff DF. International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst. 2003;95:1384-93. [PMID: 13130114] CrossrefMedlineGoogle Scholar11. Smith-Bindman R, Chu PW, Miglioretti DL, Sickles EA, Blanks R, Ballard-Barbash R, et al. Comparison of screening mammography in the United States and the United Kingdom. JAMA. 2003;290:2129-37. [PMID: 14570948] CrossrefMedlineGoogle Scholar12. Welch HG, Schwartz LM, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. 1st ed. Boston: Beacon Pr; 2012. Google Scholar13. Esserman L, Thompson I. Solving the overdiagnosis dilemma [Editorial]. J Natl Cancer Inst. 2010;102:582-3. [PMID: 20413743] CrossrefMedlineGoogle Scholar14. Jørgensen KJ, Gøtzsche PC. Content of invitations for publicly funded screening mammography. BMJ. 2006;332:538-41. [PMID: 16513713] CrossrefMedlineGoogle Scholar15. Schwartz LM, Woloshin S, Sox HC, Fischhoff B, Welch HG. US women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey. BMJ. 2000;320:1635-40. [PMID: 10856064] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington School of Medicine, Seattle, WA 98104-2499, and Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0505.Corresponding Author: Joann G. Elmore, MD, MPH, 325 Ninth Avenue, Room 10EH03, Box 359780, Seattle, WA 98104-2499.Current Author Addresses: Dr. Elmore: 325 Ninth Avenue, Room 10EH03, Box 359780, Seattle, WA 98104-2499.Dr. Fletcher: 208 Boulder Bluff, Chapel Hill, NC 27516. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOverdiagnosis of Invasive Breast Cancer Due to Mammography Screening: Results From the Norwegian Screening Program Mette Kalager , Hans-Olov Adami , Michael Bretthauer , and Rulla M. 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Gross, MDWere Our Estimates of Overdiagnosis With Mammography Screening in the United States "Based on Faulty Science"?Development of a comprehensive list of criteria for evaluating consumer education materials on colorectal cancer screeningThe benefits and harms of breast cancer screening: an independent reviewBiospecimens, biomarkers, and burgeoning data: the imperative for more rigorous research standardsBreast cancer screening: the questions answeredBreast Density Legislation and Opportunities for Patient-centered Outcomes ResearchThe Incidence of Interval Cancers in the German Mammography Screening Program 3 April 2012Volume 156, Issue 7Page: 536-537KeywordsBreast cancerBreast cancer screeningCancer screeningInfantsMagnetic resonance imagingMammographyNeuroblastomaRadiologistsUrine ePublished: 3 April 2012 Issue Published: 3 April 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...