title: Screening mammography: update and review of publications since our report in the New England Journal of Medicine on the magnitude of the problem in the United States.
abstract: OBJECTIVE
  After a half century of clinical trials, expansive observations, vigorous advocacy and debate, screening mammography could not be in a more controversial condition, especially the potential harm of overdiagnosis. Despite a simple rationale (catch the cancer early and either prevent death or at least decrease the amount of therapy needed for cure), the estimates to date of overdiagnosis rates are conflicting and the interpretations complex.
  
  
  METHODS
  Since the author's 2012 publication in the New England Journal of Medicine (NEJM), the peer-reviewed publications on overdiagnosis caused by screening mammography are reviewed and the NEJM analyses updated with three additional calendar years of results.
  
  
  RESULTS
  The recent peer-reviewed medical literature on screening mammography induced overdiagnosis of breast cancer has increased exponentially, nearly 10-fold in 10 years. The average estimate of overdiagnosis is about 30%, but the range extends from 0% to 70+%. An update of the NEJM report estimates that in the US, 78,000 women and 30%-31% of those diagnosed with breast cancer at the age of 40 years or older during 2011 were overdiagnosed.
  
  
  CONCLUSIONS
  Until we have better screening procedures that identify who really has cancer and needs to be treated, the risk of overdiagnosis relative to the benefit of screening merits more effective public and professional education. Radiologists, pathologists, and other professionals involved with screening mammography should recognize that the potential harm of overdiagnosis is downplayed or not discussed with the patient and family, despite agreement that the objective is informed choice.
authors.affiliation: Oregon Health and Science University, Portland, Oregon. Electronic address: ableyer@gmail.com.
authors.forename: Archie
authors.initials: A
authors.lastname: Bleyer
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data* / Q000639:trends; D000069342:Medical Overuse / Q000517:prevention & control / Q000706:statistics & numerical data* / Q000639:trends*; D015995:Prevalence; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000706:statistics & numerical data
keywords: Screening mammography; United States; literature review; overdiagnosis