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Estimates of overdiagnosis of invasive breast cancer associated with screening mammography

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Abstract

Purpose

To estimate the extent of overdiagnosis of invasive breast cancer associated with screening in New South Wales, Australia, a population with a well-established mammography screening program which has achieved full geographic coverage.

Methods

We calculated overdiagnosis as the observed annual incidence of invasive breast cancer in NSW in 1999–2001 (a screened population) minus the expected annual incidence in this population at the same time, as a percentage of the expected incidence. We estimated expected incidence without screening in 1999–2001 from the incidence of invasive breast cancer in: (1) women in unscreened age groups (interpolation method); and (2) women in all age groups prior to the implementation of screening (extrapolation method). We then adjusted these estimates for trends in major risk factors for breast cancer that may have coincided with the introduction of mammography screening: increasing obesity, use of hormone replacement therapy (HRT) and nulliparity. Finally, we adjusted for lead time to produce estimates of expected incidence in 1999–2001. These were compared with the observed incidence in 1999–2001 to calculate overdiagnosis of breast cancer associated with screening.

Results

Overdiagnosis of invasive breast cancer among 50–69 year NSW women was estimated to be 42 and 30% using the interpolation and extrapolation methods, respectively.

Conclusion

Overdiagnosis of invasive breast cancer attributable to mammography screening appears to be substantial. Our estimates are similar to recent estimates from other screening programmes. Overdiagnosis merits greater attention in research and in clinical and public health policy making.

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Acknowledgments

This research was funded in part by National Health and Medical Research Council Capacity Building Grant in Population Health #262121, and in part by NHMRC Program Grant #402764.

Competing Interests

All authors declare that they have no competing or conflicts of interest. The first author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia

    Stephen Morrell, Alexandra Barratt, Les Irwig, Kirsten Howard & Bruce Armstrong

  2. Screening and Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia

    Les Irwig, Kirsten Howard & Corné Biesheuvel

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

    Corné Biesheuvel

  4. Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    Bruce Armstrong

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  1. Stephen Morrell
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  2. Alexandra Barratt
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  3. Les Irwig
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  4. Kirsten Howard
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  5. Corné Biesheuvel
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  6. Bruce Armstrong
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Correspondence to Stephen Morrell.

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Morrell, S., Barratt, A., Irwig, L. et al. Estimates of overdiagnosis of invasive breast cancer associated with screening mammography. Cancer Causes Control 21, 275–282 (2010). https://doi.org/10.1007/s10552-009-9459-z

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