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October 2018

Expert Review of Breast Pathology in Borderline Lesions: A Chance to Reduce Overdiagnosis and Overtreatment?

Author Affiliations
  • 1Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
  • 2Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
  • 3PhD Program in Integrative Biomedical Research, Università degli Studi di Milano, Milan, Italy
  • 4Pathology & Cytology Dalarna, Falun, Sweden
  • 5Uppsala University, Uppsala, Sweden
JAMA Oncol. 2018;4(10):1325-1326. doi:10.1001/jamaoncol.2018.1953

Breast cancer overdiagnosis from screening mammography has been debated for many years, with estimates of over 50% when unadjusted and estimates of 1% to 10% when adjusted for breast cancer risk and lead time.1 Importantly, overdiagnosis should be distinguished into 2 types.2 Type 1 (obligate) overdiagnosis occurs when progressive cancers are typically diagnosed in older women who die of other causes before the breast cancer becomes clinically evident. Type 1 overdiagnosis is intrinsically related to any program aimed at preclinical diagnosis of any disease, and its estimation is challenged by the continuous increase in life expectancy across all countries. In fact, the American Cancer Society takes into consideration life expectancy for the definition of the upper age limit for screening mammography.3 Neither radiologists nor pathologists can be in any way blamed for type 1 overdiagnosis and its related overtreatment.

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