Ramifications of screening for breast cancer: Definition of overdiagnosis is confusing in follow-up of Malmö trial

doi:10.1136/bmj.332.7543.727-b

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Per-Henrik Zahl, senior statistician (per-henrik.zahl@fhi.no),
Jan Mæhlen, professor

Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403, Oslo, Norway
Department of Pathology, Ullevål University Hospital, N-0407 Oslo

EDITOR—In their follow-up of the Malmö mammography trial, Zackrisson et al say that the reported levels of overdiagnosis vary from 5% to 50%.1 However, to use cumulative incidence rates at the end of follow-up to quantify the level of overdiagnosis is confusing because the resulting estimates are highly sensitive to both the length of follow-up and the length of …