Overdiagnosis and mammography screening

doi:10.1136/bmj.b1425

Published 9 July 2009, doi:10.1136/bmj.b1425
Cite this as: BMJ 2009;339:b1425

Editorials

Overdiagnosis and mammography screening

The question is no longer whether, but how often, it occurs

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

The NHS recently scrapped its leaflet inviting women to undergomammography in response to criticisms that it failed to mentionthe major harm of screening—overdiagnosis.¹ In the linkedsystematic review (doi:10.1136/bmj.b2587), Jørgensenand Gøtzsche provide evidence that screening has ledto overdiagnosis of breast cancer not only in the United Kingdom,but also in Canada, Australia, Sweden, and Norway.²

Overdiagnosis refers to the detection of abnormalities thatwill never cause symptoms or death during a patient’slifetime. Overdiagnosis of cancer occurs when the cancer growsso slowly that the patient dies of other causes before it producessymptoms or when the cancer remains dormant (or regresses).Because doctors don’t know which patients are overdiagnosed,we tend to treat them all. Overdiagnosis therefore results inunnecessary treatment.

With the advent of widespread efforts to diagnose cancer earlier,overdiagnosis has become an increasingly vexing problem. Overdiagnosisis a widely recognised . . . [Full text of this article]

H Gilbert Welch, professor of medicine

¹ VA Outcomes Group and the Dartmouth Institute for Health Policy and Clinical Research, White River Junction, VT 80302, USA

h.gilbert.welch@dartmouth.edu

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