Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers

doi:10.1136/bmj.332.7543.727

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H Gilbert Welch, professor of medicine (h.gilbert.welch@dartmouth.edu),
Lisa M Schwartz, associate professor of medicine,
Steven Woloshin, associate professor of medicine

VA Outcomes Group, White River Junction, VT 05009, USA

EDITOR—In this issue Zackrisson et al report on follow-up data from the Malmö mammographic screening trial and conclude that the rate of overdiagnosis of breast cancer was 10%.1 They do not, however, calculate the risk we believe is most relevant to women considering mammography: What is the chance that a screen detected cancer represents overdiagnosis?

After 15 years of follow-up, there were 1320 diagnosed in the screened …