Published 11 August 2009, doi:10.1136/bmj.b3262
Cite this as: BMJ 2009;339:b3262

Letters

Breast screening overdiagnosis

Protocols are evidence based

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

The editorial accompanying the paper by Jørgensen and Gøtzsche indicates the challenges to identify the numbers of non-lethal breast cancers detected by screening, a question which remains unanswered by the paper.^{1 2}

More extensive scrutiny of the authors’ adjustments for the known rising incidence of breast cancer, including the effect of hormone replacement therapy, is needed to validate their claims. Similarly, analysis of grade of ductal carcinoma in situ (DCIS) is crucial before dismissing the condition as "overdiagnosis." High grade (grade 3) DCIS presents considerably more challenges than low grade DCIS, and 57% of screen detected DCIS in the UK National Screening Programme is high grade.³

Recognising that organised, population based screening is a programme rather than an individual test, the monitoring of performance against agreed criteria and standards is pivotal in maximising the benefits and minimising the harm of screening. Muir Gray et al showed continuous quality improvement in the . . . [Full text of this article]

¹ Quality Assurance Reference Centre, Scottish Breast Screening Programme, ² NHS Lothian

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