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March 17, 2010

Screening and Detection of Breast Cancer and Prostate Cancer

JAMA. 2010;303(11):1032-1034. doi:10.1001/jama.2010.273

To the Editor: The Special Communication by Dr Esserman and colleagues1 summarized several observations after 20 years of extensive screening for breast and prostate cancer (1986-2006). The authors referred to data from the Surveillance, Epidemiology and End Results (SEER) program to report that the incidence of total invasive breast cancer (excluding in situ lesions) has increased substantially and remains higher than prescreening rates, while the localized (node negative, no skin or chest wall involvement) and regional (node positive, skin or chest wall involvement) breast cancer incidence has declined only slightly. The authors concluded that the increase in the relative fraction of early stage cancers without decrease in the incidence of regional cancers is the result of preferential detection of the slower growing and potentially indolent tumors (length bias).