Accepting the existence of breast cancer overdiagnosis

Abstract

Editorials7 March 2017Accepting the Existence of Breast Cancer OverdiagnosisOtis W. Brawley, MDOtis W. Brawley, MDFrom American Cancer Society, Atlanta, Georgia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2850 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Jørgensen and colleagues (1) compare breast cancer incidence and death rates in several areas of Denmark where screening was introduced at various times in the 1990s. Although the incidence of localized disease increased with the introduction of screening, the incidence of advanced disease has not decreased. They estimate that screen-detected breast tumors have an overdiagnosis rate of 14.7% to 38.6% (excluding ductal carcinoma in situ). This is the latest of several studies using various methods and data sets to show that the phenomenon of overdiagnosis exists in breast cancer. Estimates of this overdiagnosis rate vary but range up to 54% ...References1. Jørgensen KJ, Gøtzsche PC, Kalager M, Zahl PH. Breast cancer screening in Denmark. A cohort study of tumor size and overdiagnosis. Ann Intern Med. 2017;166:313-23. doi:10.7326/M16-0270 LinkGoogle Scholar2. Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force Recommendation. Ann Intern Med. 2016;164:256-67. [PMID: 26756737]. doi:10.7326/M15-0970 LinkGoogle Scholar3. Kopans DB. Point: The New England Journal of Medicine article suggesting overdiagnosis from mammography screening is scientifically incorrect and should be withdrawn. J Am Coll Radiol. 2016;13:R50-R52. [PMID: 27814814] doi:10.1016/j.jacr.2016.09.026 CrossrefMedlineGoogle Scholar4. Brawley OW, O'Regan RM. Breast cancer screening: time for rational discourse [Editorial]. Cancer. 2014;120:2800-2. [PMID: 24925095] doi:10.1002/cncr.28788 CrossrefMedlineGoogle Scholar5. David H. Rudolf Virchow and modern aspects of tumor pathology. Pathol Res Pract. 1988;183:356-64. [PMID: 3047716] CrossrefMedlineGoogle Scholar6. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102:605-13. [PMID: 20413742] doi:10.1093/jnci/djq099 CrossrefMedlineGoogle Scholar7. Welch HG, Prorok PC, O'Malley AJ, Kramer BS. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2016;375:1438-1447. [PMID: 27732805] CrossrefMedlineGoogle Scholar8. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al; Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353:1784-92. [PMID: 16251534] CrossrefMedlineGoogle Scholar9. Griggs JJ, Hawley ST, Graff JJ, Hamilton AS, Jagsi R, Janz NK, et al. Factors associated with receipt of breast cancer adjuvant chemotherapy in a diverse population-based sample. J Clin Oncol. 2012;30:3058-64. [PMID: 22869890] doi:10.1200/JCO.2012.41.9564 CrossrefMedlineGoogle Scholar10. Rutter CE, Yao X, Mancini BR, Aminawung JA, Chagpar AB, Saglam O, et al. Influence of a 21-gene recurrence score assay on chemotherapy delivery in breast cancer. Clin Breast Cancer. 2016;16:59-62. [PMID: 26483315] doi:10.1016/j.clbc.2015.09.008 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From American Cancer Society, Atlanta, Georgia.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2850.Corresponding Author: Otis W. Brawley, MD, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303; e-mail, otis.[email protected]org.This article was published at Annals.org on 10 January 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBreast Cancer Screening in Denmark Karsten Juhl Jørgensen , Peter C. Gøtzsche , Mette Kalager , and Per-Henrik Zahl Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians Amir Qaseem , Timothy J. Wilt , Robert Rich , Linda L. Humphrey , Jennifer Frost , Mary Ann Forciea , and Metrics Cited byNational surveillance of cancer survival in Iran ( IRANCANSURV ): Analysis of data of 15 cancer sites from nine population‐based cancer registriesComparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening Among Women 40-64 Years OldAssessment of cancer screening effectiveness in the era of screening programsCancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institutionIdentification of a Prognostic Signature Associated With DNA Repair Genes in Ovarian CancerTime to abandon early detection cancer screeningImpact of Overdiagnosis on Long-Te