Counterpoint: Overdiagnosis in Breast Cancer Screening

Abstract

INTRODUCTION In the ongoing debate over the balance of benefits and harms associated with breast cancer screening, overdiagnosis has become the dommage du jour. Dr Berlin [1] is right to be concerned about overdiagnosis. There can be no argument that treatment of a nonprogressive, mammographically detected lesion is the greatest possible harm associated with breast cancer screening, and to the extent that overdiagnosis exists, women need to be informed of that possibility. However, the magnitude of overdiagnosis in breast cancer screening is uncertain, with a wide range of estimates (0% to >50%) deriving from a wide range of study methodologies [2]. Estimating the magnitude of overdiagnosis in breast cancer screening is exceedingly complex, although we can say with confidence that the most credible estimates are considerably smaller than thoseBerlin cites. Thus, he overpromises when he asserts that his commentary on overdiagnosis is “the truth vs. whole truth, vs. nothing but the truth.”