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Rapid response to:


Risk of overdiagnosis doesn’t deter women from breast cancer screening, study finds

BMJ 2013; 346 doi: (Published 23 April 2013) Cite this as: BMJ 2013;346:f2621

Rapid Response:

Re: Risk of overdiagnosis doesn’t deter women from breast cancer screening, study finds

The battle between proponents and opponents of breast screening has reached a well entrenched stalemate. (1). A new randomised trial which could confirm or refute breast screening benefits is not realistically feasible.

The women's views in this study offers an elegant way forward. (2). We need to untangle the issue of over- treatment from over- diagnosis. Rather than concentrating on over- diagnosis, the option of active surveillance for low grade lesions needs to be explored.

The use of PSA screening in men coupled with active surveillance for low risk prostate cancer suggests that this approach is clinically feasible. (3). Non- prostate clinicians should note that active surveillance is different from wait &watch policy. Active surveillance implies close clinical observation followed by active curative treatment when there is progression of lesions (low grade cancer or DCIS) whereas a wait &watch policy implies symptom directed, often palliative, management of cancer.

A feasibility study followed by a large scale randomised study of active surveillance for 'low- risk' screen detected lesions (DCIS or cancer) is urgently needed. Cancer Research UK should use its considerable resources to kick start an active surveillance trial for women.


1. Independent UK Panel on Breast Cancer Screening, The benefits and harms of breast cancer screening: an independent review. Lancet 2012;380:1778-86

2. Waller J, Douglas E, Whitaker KL, Wardle J. Women’s responses to information about overdiagnosis in the UK breast screening programme: a qualitive study. BMJ Open 22 Apr 2013, doi:10.1136/bmjopen-2013-002703.

3. NICE clinical guideline 58. Prostate cancer: diagnosis and treatment. 2008. (accessed 29 April 2013).

Competing interests: No competing interests

30 April 2013
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospitals NHS trust