In Reply Our study examined all 7375 black women older than 65 years diagnosed with breast cancer between 1991 and 2005 in the Surveillance, Epidemiology, and End Results database. Although Mr Harding and colleagues quote various numbers to illustrate the potential effect of overdiagnosis on racial disparities in breast cancer survival, these are hypothetical.
We matched patients for cancer stage and many other characteristics, in which stage was determined from the database based on chart review. That chart review included information from biopsy and postsurgical pathology. On this basis, patients with ductal carcinoma in situ (DCIS) were excluded from our data set. Although overdiagnosis may lead to unnecessary biopsies or unneeded treatment of patients with DCIS, neither of these possibilities are relevant to our study. Harding and colleagues cite an Editorial by Esserman et al1 that referred to the problematic diagnosis of DCIS when estimating cancer survival and suggest that premalignant conditions “(eg, ductal carcinoma in situ or high-grade prostatic intraepithelial neoplasia) should not be labeled as cancers or neoplasia, nor should the word ‘cancer’ be in the name.” Harding and colleagues suggest an additional analysis that takes account of breast cancer screening.
Silber JH, Rosenbaum PR, Fox KR. Differences in Breast Cancer Survival by Race—Reply. JAMA. 2013;310(22):2457. doi:10.1001/jama.2013.281075