title: Benefits and harms of detecting clinically occult breast cancer.
abstract: Over the last few decades there has been an increase in the use of strategies to detect clinically occult breast cancer with the aim of achieving diagnosis at an earlier stage when prognosis may be improved. Such strategies include screening mammography in healthy women, diagnostic imaging and axillary staging in those diagnosed with breast cancer, and the use of follow-up imaging for the early detection of recurrent or metastatic disease. Some of these strategies are established, whereas for others there are inconsistent supportive data. Although the potential benefit of early detection of clinically occult breast cancer seems intuitive, use of such strategies can also be associated with harm. In this commentary, we provide an extended discussion on the potential benefits and harms of the routine and frequent use of screening interventions to detect clinically occult breast cancer and question whether we may be causing more harm than good.
authors.affiliation: Division of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave 5-124, Toronto, ON M5G 2M9, Canada. eitan.amir@uhn.ca
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Bedard
authors.forename: Alberto
authors.initials: A
authors.lastname: Ocaña
authors.forename: Bostjan
authors.initials: B
authors.lastname: Seruga
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D055088:Early Detection of Cancer / Q000009:adverse effects; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008327:Mammography / Q000592:standards; D008403:Mass Screening / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy; D013315:Stress, Psychological / Q000209:etiology*; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000639:trends