Published 11 August 2009, doi:10.1136/bmj.b3256
Cite this as: BMJ 2009;339:b3256

Letters

Breast screening overdiagnosis

Stop treating indolent lesions

The first 150 words of the full text of this article appear below.

Jørgensen and Gøtzsche estimate overdiagnosis by mammographic screening programmes to be 52%, making assumptions about incidence changes from age groups too young to be screened.¹ But Zackrisson et al measured the rate as 10%.² That Jørgensen and Gøtzsche did not discuss or reference this study is surprising.

In the accompanying editorial Welch says: "Overdiagnosis is a function of the mammographer’s threshold to recommend biopsy. The time has come for a randomised controlled trial to test higher thresholds such as only recommending biopsy for breast masses larger than a certain size."³ However, overdiagnosis relates to tumour biology, not tumour size, and many lesions show as calcification or distortions rather than masses. The most aggressive anti-screener would admit that detecting 5 mm grade 3 invasive cancers in women aged 50 is almost never overdiagnosis, while the most fervent screening evangelist would admit that detecting 50 mm areas of low grade ductal carcinoma . . . [Full text of this article]

¹ Breast Institute, City Campus, Nottingham NG5 1PB

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