Letters Net harms of breast screening

Randomised controlled trial needed to determine necessity of surgery for “atypical” breast lesions

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e890 (Published 21 February 2012) Cite this as: BMJ 2012;344:e890
  1. Nik Makretsov, pathologist1
  1. 1St Paul’s Hospital, Vancouver, Canada
  1. NMakretsov{at}providencehealth.bc.ca

“Unnecessary surgery” as a possible harm from breast cancer screening needs to be elucidated.1 Many indeterminate or “atypical” breast lesions are found on breast core biopsy after abnormal results in screening mammography.

Most current recommendations assume that surgery is beneficial as it provides the final diagnosis and determines whether invasive cancer or ductal carcinoma in situ is present. The relative risk associated with these “indeterminate core biopsy diagnoses” (flat epithelial atypia, atypical ductal hyperplasia, and so on) is poorly defined in conflicting observational studies. The final diagnosis of invasive carcinoma can be established in only a small proportion of surgical excisions, while the diagnosis of ductal carcinoma in situ can be established in up to 30% of them. This means false negative results—that is, no type of cancer on surgical excision—in up to 70% of patients with a preliminary pathology diagnosis of “atypia.”

High quality randomised controlled trials are needed to determine whether surgical excision is necessary for ductal carcinoma in situ and atypia detected by screening and core biopsy and so reduce the rates of unnecessary surgery in patients with abnormal results on mammography screening.


Cite this as: BMJ 2012;344:e890


  • Competing interests: None declared.