Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program
- PMID:22473436
- DOI: 10.7326/0003-4819-156-7-201204030-00005
Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program
Abstract
Background: Precise quantification of overdiagnosis of breast cancer (defined as the percentage of cases of cancer that would not have become clinically apparent in a woman's lifetime without screening) due to mammography screening has been hampered by lack of valid comparison groups that identify incidence trends attributable to screening versus those due to temporal trends in incidence.
Objective: To estimate the percentage of overdiagnosis of breast cancer attributable to mammography screening.
Design: Comparison of invasive breast cancer incidence with and without screening.
Setting: A nationwide mammography screening program in Norway (inviting women aged 50 to 69 years), gradually implemented from 1996 to 2005.
Participants: The Norwegian female population.
Measurements: Concomitant incidence of invasive breast cancer from 1996 to 2005 in counties where the screening program was implemented compared with that in counties where the program was not yet implemented. To adjust for changes in temporal trends in breast cancer incidence, incidence rates during the preceding decade were also examined. The percentage of overdiagnosis was calculated by accounting for the expected decrease in incidence following cessation of screening after age 69 years (approach 1) and by comparing incidence in the current screening group with incidence among women 2 and 5 years older in the historical screening groups, accounting for average lead time (approach 2).
Results: A total of 39,888 patients with invasive breast cancer were included, 7793 of whom were diagnosed after the screening program started. The estimated rate of overdiagnosis attributable to the program was 18% to 25% (P < 0.001) for approach 1 and 15% to 20% (P < 0.001) for approach 2. Thus, 15% to 25% of cases of cancer are overdiagnosed, translating to 6 to 10 women overdiagnosed for every 2500 women invited.
Limitation: The study was registry-based.
Conclusion: Mammography screening entails a substantial amount of overdiagnosis.
Primary funding source: Norwegian Research Council and Frontier Science.
Comment in
- Overdiagnosis in breast cancer screening: time to tackle an underappreciated harm.Elmore JG, Fletcher SW.Elmore JG, et al.Ann Intern Med. 2012 Apr 3;156(7):536-7. doi: 10.7326/0003-4819-156-7-201204030-00012.Ann Intern Med. 2012.PMID:22473439Free PMC article.No abstract available.
- Overdiagnosis of Invasive Breast Cancer due to Mammography Screening.Falk RS, Hofvind S, Skaane P.Falk RS, et al.Ann Intern Med. 2012 Aug 7;157(3):219; author reply 221-2. doi: 10.7326/0003-4819-157-3-201208070-00021.Ann Intern Med. 2012.PMID:22868848No abstract available.
- Overdiagnosis of invasive breast cancer due to mammography screening.Jørgensen KJ.Jørgensen KJ.Ann Intern Med. 2012 Aug 7;157(3):219-20; author reply 221-2. doi: 10.7326/0003-4819-157-3-201208070-00022.Ann Intern Med. 2012.PMID:22868849No abstract available.
- Overdiagnosis of invasive breast cancer due to mammography screening.Haldorsen T, Tretli S, Ursin G.Haldorsen T, et al.Ann Intern Med. 2012 Aug 7;157(3):220; author reply 221-2. doi: 10.7326/0003-4819-157-3-201208070-00023.Ann Intern Med. 2012.PMID:22868850No abstract available.
- Overdiagnosis of invasive breast cancer due to mammography screening.Zahl PH.Zahl PH.Ann Intern Med. 2012 Aug 7;157(3):220-1; author reply 221-2. doi: 10.7326/0003-4819-157-3-201208070-00024.Ann Intern Med. 2012.PMID:22868851No abstract available.
- Mammography screening in Norway caused substantial overdiagnosis and did not reduce late-stage breast cancers.Jørgensen KJ.Jørgensen KJ.Evid Based Med. 2013 Apr;18(2):e17. doi: 10.1136/eb-2012-100806. Epub 2012 Aug 25.Evid Based Med. 2013.PMID:22923706No abstract available.
- Does screening mammography lead to overdiagnosis of invasive breast cancer?Endres J, Graber MA, Dachs R.Endres J, et al.Am Fam Physician. 2013 Mar 15;87(6):408-9.Am Fam Physician. 2013.PMID:23547573No abstract available.
Summary for patients in
- Summaries for patients: Overdiagnosis of invasive breast cancer with mammography screening.[No authors listed][No authors listed]Ann Intern Med. 2012 Apr 3;156(7):I58. doi: 10.7326/0003-4819-156-7-201204030-00001.Ann Intern Med. 2012.PMID:22473444No abstract available.
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