Model of outcomes of screening mammography: Authors' reply

doi:10.1136/bmj.331.7512.351-a

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Alexandra Barratt, associate professor of epidemiology (alexb@health.isyd.edu.au),
Kirsten Howard, research fellow health economics,
Les Irwig, professor of epidemiology,
Glenn Salkeld, associate professor of health economics,
Nehmat Houssami, clinical associate and honorary senior lecturer

Screening and Test Evaluation Programme, School of Public Health, University of Sydney, NSW 2006, Australia

EDITOR—Zahl and Mæhlen and G⊘tzsche and J⊘rgensen cite a variety of evidence, consistent with our model, to propose that overdetection (and potentially overtreatment) may be substantial in breast screening. Furthermore, Zahl and Mæhlen say that the biological mechanisms underlying the observed overdetection may include regression of small cancers, as well as non-progression.

Although the frequency of regression is as yet very unclear, evidence from epidemiology and cancer biology …