Estimations of overdiagnosis in breast cancer screening vary between 0% and over 50%: why?
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  • Published on:
    If not overdiagnosis, what are these excess cancers?

    Chaltiel and Hill show that studies based on individual data indicate a low percentage of overdiagnosis from mammography screening. How to explain the vast excess of cancers that is consistently associated to mammography screening in observations on aggregated data? We have shown that this excess occur after more than 5 years after mammography, in every country, and can only be interpreted as originating from radiation-induced cancers (1,2).
    The absence of discussion on this issue is worrying, because Catherine Hill is perfectly aware that I have been dismissed from my permanent position at the INSERM after alerting on these mammography-induced cancers.

    1) Corcos D. Breast cancer incidence as a function of the number of previous mammograms: analysis of the NHS screening programme. BioRxiv 2017. doi: .
    2) Corcos D & Bleyer A. Epidemiologic Signatures in Cancer. New Engl J Med. 2020. 382(1):96. doi: 10.1056/NEJMc1914747

    Conflict of Interest:
    None declared.
  • Published on:
    When talking about evidence on overdiagnosis, complexity is not a substitute for quality
    • Alexandra BARRATT, Professor of Public Health Wiser Healthcare, University of Sydney
    • Other Contributors:
      • Karsten Jørgensen, MD, DMedSci
      • Philippe Autier, Director Population Research
      • Barnett S Kramer, Public Health Researcher

    When the Independent UK Panel, led by Sir Michael Marmot, estimated breast cancer overdiagnosis they used the gold standard - randomised trials with long follow-up without screening in the control group. The Panel chose not to use the observational studies because “this method could give no reliable estimate of the extent of overdiagnosis.”(1) Inherent biases in observational studies are also the reason that the UK National Screening Committee requires high-quality, randomised trial evidence on benefits and harm before screening is introduced.(2)

    Conversely, Chaltiel and Hill (3) dismiss the gold standard estimates of overdiagnosis and focus on an observational study (4) while they reject the estimates from another observational study (5) that agrees more closely with those of the randomized trials. Notably the estimates from the trials were consistent with each other. Chaltiel and Hill’s choice conflicts with the fundamental principles of evidence-based medicine.

    An impartial assessment of the risk of bias of all observational studies of breast cancer overdiagnosis found that many studies, including ones using individual data, were at high risk of bias because of selection bias, confounding, inadequate adjustment for lead time and non-transparent methods.(6) It is misleadingly simplistic to assert that having individual level data provides protection against significant bias, as we explain below.

    Chaltiel and Hill’s study design of choice is an...

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    Conflict of Interest:
    Dr Barratt holds a grant from the National Health and Medical Research Council of Australia and is a member of the Preventing Overdiagnosis Conference Scientific Committee. Dr. Kramer has no financial competing interests. He is a member of the Preventing Overdiagnosis Conference Scientific Committee. Dr Jorgensen and Dr Autier have no competing interests to declare.