Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends

doi:10.1136/bmj.b2587

Published 9 July 2009, doi:10.1136/bmj.b2587
Cite this as: BMJ 2009;339:b2587

Research

Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends

Karsten Juhl Jørgensen, researcher, Peter C Gøtzsche, director

¹ The Nordic Cochrane Centre, Rigshospitalet, Dept 3343, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

Correspondence to: K J Jørgensen kj{at}cochrane.dk

Objective To estimate the extent of overdiagnosis (the detectionof cancers that will not cause death or symptoms) in publiclyorganised screening programmes.

Design Systematic review of published trends in incidence ofbreast cancer before and after the introduction of mammographyscreening.

Data sources PubMed (April 2007), reference lists, and authors.

Review methods One author extracted data on incidence of breastcancer (including carcinoma in situ), population size, screeninguptake, time periods, and age groups, which were checked independentlyby the other author. Linear regression was used to estimatetrends in incidence before and after the introduction of screeningand in older, previously screened women. Meta-analysis was usedto estimate the extent of overdiagnosis.

Results Incidence data covering at least seven years beforescreening and seven years after screening had been fully implemented,and including both screened and non-screened age groups, wereavailable from the United Kingdom; Manitoba, Canada; New SouthWales, Australia; Sweden; and parts of Norway. The implementationphase with its prevalence peak was excluded and adjustment madefor changing background incidence and compensatory drops inincidence among older, previously screened women. Overdiagnosiswas estimated at 52% (95% confidence interval 46% to 58%). Datafrom three countries showed a drop in incidence as the womenexceeded the age limit for screening, but the reduction wassmall and the estimate of overdiagnosis was compensated forin this review.

Conclusions The increase in incidence of breast cancer was closelyrelated to the introduction of screening and little of thisincrease was compensated for by a drop in incidence of breastcancer in previously screened women. One in three breast cancersdetected in a population offered organised screening is overdiagnosed.

© Jørgensen et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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