Sir,
In a recent paper, Bucchi et al (2005) report that the risk of axillary lymph node metastases for screening detected cancers is increasing more rapidly than for clinically detected cancers even after adjusting for other risk factors. They argue that overdiagnosis may not explain their results. I believe that overdiagnosis actually may explain their results.
Further, Bucchi et al claim there is ‘no published data support on an inverse association between overdiagnosis and tumour size’. Actually, there are a lot of recent papers on the association between mammography screening and overdiagnosis of small tumours (Olsen and Gotzsche, 2001); (Zahl et al, 2004). Most recently, Joensuu et al (2004) reported an extremely high level of length time bias in screening detected cancers in the Finnish mammography screening programme.
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16 November 2011
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References
Bucchi L, Barchielli A, Ravaioli A, Federico M, De Lisi V, Ferretti S, Paci E, Vettorazzi M, Patriarca S, Frigerio A, Buiatti E, the SCREENREG Working Group (2005) Screening-detected vs clinical breast cancer: the advantage in the relative risk of lymph node metastases decreases with increasing tumour size. Br J Cancer 92: 156–161
Joensuu H, Lehtimäki T, Holli K, Elomaa L, Turpeenniemi-Hujanen T, Kataja V, Anttila A, Lundin M, Isola J, Lundin J (2004) Risk for distant recurrence of breast cancer detected by mammography screening or other methods. JAMA 292: 1064–1073
Olsen O, Gotzsche PC (2001) Cochrane review on screening for breast cancer with mammography. Lancet 358: 1340–1342
Zahl P-H, Strand BH, Maehlen J (2004) Breast cancer incidence in Norway and Sweden during introduction of nation-wide screening: prospective cohort study. Br Med J 328: 921–924
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Zahl, PH. An inverse association between tumour size and overdiagnosis may explain the results by Bucchi et al. Br J Cancer 92, 1814 (2005). https://doi.org/10.1038/sj.bjc.6602581
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DOI: https://doi.org/10.1038/sj.bjc.6602581
