News | Mammography | January 19, 2017

Breast Cancer Screening Associated with Substantial Overdiagnosis

Danish study finds approximately 1 in 3 invasive tumors and DCIS cases diagnosed in screened women did not require any action

breast cancer screening, substantial overdiagnosis, Annals of Internal Medicine study

January 19, 2017 — Breast cancer screening in Denmark was associated with a substantial increase in the incidence of nonadvanced tumors and ductal carcinoma in situ (DCIS) but not with a reduction in the incidence of advanced tumors. The rate of overdiagnosis was also substantial. The findings of a cohort study are published in Annals of Internal Medicine.

Effective breast cancer screening should detect early-stage cancer and prevent advanced disease. Overdiagnosis occurs when mammography detects small tumors that may never affect the patient's health during a lifetime. The problem with overdiagnosis is that it exposes patients to the potential harms of treatment, such as surgery, chemotherapy and radiation, without a clinical benefit. Whether screening reduces the incidence of advanced tumors has important treatment implications.

Using data from two comprehensive Danish cancer registries, researchers sought to examine the association of screening with a reduction in the incidence of advanced cancer and estimate the level of overdiagnosis in the country's breast screening program. Denmark’s breast screening program offered biennial mammography for women aged 50 - 69 years beginning in different regions at different times. The authors measured the incidence of advanced and nonadvanced breast cancer tumors in screened and unscreened women. To examine trends in overdiagnosis, the authors compared the incidence of advanced tumors in women aged 50 to 84 in screening and nonscreening areas and compared the incidence for nonadvanced tumors among women aged 35 to 49, 50 to 69, and 70 to 84 years in both screening and nonscreening areas. They concluded that screening was not associated with lower incidence of advanced tumors and approximately 1 in 3 invasive tumors and cases of DCIS diagnosed in screened women represent overdiagnosis.

In an accompanying editorial, Otis Brawley, M.D., MACP, chief medical officer of the American Cancer Society, said that it's time to accept that overdiagnosis is real and that the benefits of breast screening have been overstated. He writes that "considering all small breast cancer lesions to be deadly aggressive cancer is the pathology equivalent of racial profiling." This does not mean that screening should be abandoned, but we should try to recognize its limitations, use it in the most effective way possible, and try to improve it. Brawley suggested that more emphasis should be focused on preventing breast cancer through diet, weight control and exercise.

For more information: www.annals.org

References

Jorgensen, K.J., Gotzsche, P.C., Kalager, M., Zahl, P-H. "Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis." Annals of Internal Medicine. Published online Jan. 10, 2017. DOI: 10.7326/M16-0270

Related Content

IBM collected a dataset of 52,936 images from 13,234 women who underwent at least one mammogram between 2013 and 2017.

IBM collected a dataset of 52,936 images from 13,234 women who underwent at least one mammogram between 2013 and 2017, and who had health records for at least one year prior to the mammogram. The algorithm was trained on 9,611 mammograms. Image courtesy of Radiology.

Feature | Artificial Intelligence | July 19, 2019 | Michal Chorev
Breast cancer is the global leading cause of cancer-related deaths in women, and the most commonly diagnosed cancer...
Paragon Biosciences Launches Qlarity Imaging to Advance FDA-cleared AI Breast Cancer Diagnosis System

Qlarity Imaging’s software is used to assist radiologists in the assessment and characterization of breast lesions. Imaging features are synthesized by an artificial intelligence algorithm into a single value, the QI score, which is analyzed relative to a database of reference abnormalities with known ground truth. Image courtesy of Business Wire.

Technology | Artificial Intelligence | July 18, 2019
Paragon Biosciences LLC announced the launch of its seventh portfolio company, Qlarity Imaging LLC, which was founded...
FDA Clears Koios DS Breast 2.0 AI-based Software
News | Ultrasound Women's Health | July 11, 2019
Koios Medical announced its second 510(k) clearance from the U.S. Food and Drug Administration (FDA).
SimonMed Imaging Implements ProFound AI for 3-D Tomosynthesis
News | Mammography | July 10, 2019
Arizona-based SimonMed Imaging announced their implementation of the first U.S. Food and Drug Administration (FDA)-...
Delta T1 Maps Provide Quantitative, Automated Solution to Assess Brain Tumor Burden
News | Neuro Imaging | July 05, 2019
Imaging Biometrics LLC (IB) a subsidiary of IQ-AI Ltd., is highlighting a recently published study in the American...
Therapixel Appoints Matthieu Leclerc-Chalvet as CEO
News | Artificial Intelligence | July 03, 2019
Artificial intelligence (AI) breast cancer screening specialist Therapixel announced the appointment of Matthieu...
GE Healthcare showcases Senographe Pristina Serena featuring its add-on-biopsy kit at the Breast Imaging Symposium. Photo by Greg Freiherr

GE Healthcare showcases Senographe Pristina Serena featuring its add-on-biopsy kit at the Breast Imaging Symposium. Photo by Greg Freiherr

Feature | Breast Imaging | July 03, 2019 | By Greg Freiherr
Productivity and its enabler — efficiency — guided the display of products at the April...
Countless possibilities can impact the future of global healthcare and AI is the first step toward breakthrough that will change the landscape of personalized medicine
Feature | Women's Health | July 03, 2019 | By Samir Parikh
Contrary to what many people believe,...

Image courtesy of GE Healthcare

Feature | Radiology Business | July 03, 2019 | By Jeffrey Hoffmeister, M.D.
Burnout in the medical profession is not uncommon, particularly as clinicians have become more overwhelmed by growing