Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort

Marc D. Ryser, Jane Lange, Lurdes Y.T. Inoue, Ellen S. O’Meara, Charlotte Gard, Diana L. Miglioretti, Jean Luc Bulliard, Andrew F. Brouwer, E. Shelley Hwang, Ruth B. Etzioni

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Mammography screening can lead to overdiagnosis—that is, screen-detected breast cancer that would not have caused symptoms or signs in the remaining lifetime. There is no consensus about the frequency of breast cancer overdiagnosis. Objective: To estimate the rate of breast cancer overdiagnosis in contemporary mammography practice accounting for the detection of nonprogressive cancer. Design: Bayesian inference of the natural history of breast cancer using individual screening and diagnosis records, allowing for nonprogressive preclinical cancer. Combination of fitted natural history model with life-table data to predict the rate of overdiagnosis among screen-detected cancer under biennial screening. Setting: Breast Cancer Surveillance Consortium (BCSC) facilities. Participants: Women aged 50 to 74 years at first mammography screen between 2000 and 2018. Measurements: Screening mammograms and screen-detected or interval breast cancer. Results: The cohort included 35986 women, 82677 mammograms, and 718 breast cancer diagnoses. Among all preclinical cancer cases, 4.5% (95% uncertainty interval [UI], 0.1% to 14.8%) were estimated to be nonprogressive. In a program of biennial screening from age 50 to 74 years, 15.4% (UI, 9.4% to 26.5%) of screen-detected cancer cases were estimated to be overdiagnosed, with 6.1% (UI, 0.2% to 20.1%) due to detecting indolent preclinical cancer and 9.3% (UI, 5.5% to 13.5%) due to detecting progressive preclinical cancer in women who would have died of an unrelated cause before clinical diagnosis. Limitations: Exclusion of women with first mammography screen outside BCSC. Conclusion: On the basis of an authoritative U.S. population data set, the analysis projected that among biennially screened women aged 50 to 74 years, about 1 in 7 cases of screen-detected cancer is overdiagnosed. This information clarifies the risk for breast cancer overdiagnosis in contemporary screening practice and should facilitate shared and informed decision making about mammography screening.

Original languageEnglish (US)
Pages (from-to)471-478
Number of pages8
JournalAnnals of internal medicine
Issue number4
StatePublished - Apr 1 2022
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine


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