To the Editor In the article “Risk of Malignant Ovarian Cancer Based on Ultrasonography Findings in a Large Unselected Population,” Smith-Bindman and coauthors1 reviewed ultrasounds from 1043 women (142 ovarian cancer cases with 7 controls per case) and extrapolated the findings to a larger retrospective cohort, concluding that simple cysts are common and rarely associated with cancer—a finding that has been shown by several previous studies. While lack of awareness of the evidence supporting the benign nature of simple cysts may contribute to excessive follow-up, in our opinion, the bigger driver of overdiagnosis and overtreatment of benign adnexal masses is lack of standardization of ultrasound reports. Without standardization, a simple cyst may be reported as “simple cyst,” “cyst,” “anechoic cyst,” “hypoechoic mass,” “cystic lesion,” or any number of other descriptions, not infrequently attached to phrases such as “cannot rule out neoplasm” or “worrisome for ovarian neoplasm,” or “follow-up recommended.” Similarly, the word “complex” is used to describe both small functional cysts and large cystic and solid tumors and thus has no consistent correlation with risk.