{"id":5765,"date":"2016-10-14T15:19:46","date_gmt":"2016-10-14T13:19:46","guid":{"rendered":"https:\/\/www.caperay.com\/blog\/?p=5765"},"modified":"2016-10-14T20:36:13","modified_gmt":"2016-10-14T18:36:13","slug":"overdiagnosis-in-the-spotlight-again","status":"publish","type":"post","link":"https:\/\/www.caperay.com\/blog\/overdiagnosis-in-the-spotlight-again\/","title":{"rendered":"&#8216;Overdiagnosis&#8217; in the Spotlight \u2013 Again"},"content":{"rendered":"\n<!-- Facebook Like Button v1.9.6 BEGIN [http:\/\/blog.bottomlessinc.com] -->\n<iframe src=\"http:\/\/www.facebook.com\/plugins\/like.php?href=https%3A%2F%2Fwww.caperay.com%2Fblog%2Foverdiagnosis-in-the-spotlight-again%2F&amp;layout=standard&amp;show_faces=false&amp;width=300&amp;action=like&amp;colorscheme=light&amp;font=arial\" scrolling=\"no\" frameborder=\"0\" allowTransparency=\"true\" style=\"border:none; overflow:hidden; width:300px; height: 30px; align: left; margin: 2px 0px 15px 0px\"><\/iframe>\n<!-- Facebook Like Button END -->\n<p><a href=\"https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Welch_NEJM_2016_Figure2A.jpg\" target=\"_blank\"><img decoding=\"async\" class=\"alignright wp-image-5769 size-full\" src=\"https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Welch_NEJM_2016_Figure2A.jpg\" width=\"400\" srcset=\"https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Welch_NEJM_2016_Figure2A.jpg 1474w, https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Welch_NEJM_2016_Figure2A-300x181.jpg 300w, https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Welch_NEJM_2016_Figure2A-768x464.jpg 768w, https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Welch_NEJM_2016_Figure2A-1024x619.jpg 1024w\" sizes=\"(max-width: 1474px) 100vw, 1474px\" \/><\/a>The <em>New England Journal of Medicine<\/em> (<em>NEJM<\/em>) yesterday\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1600249\" target=\"_blank\">published a paper<\/a>\u00a0entitled \u201cBreast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.\u201d Lead author Gilbert Welch from Dartmouth and his co-authors analysed 37 years of data from the Surveillance, Epidemiology and End Results (<a href=\"http:\/\/seer.cancer.gov\/\" target=\"_blank\">SEER<\/a>) programme to calculate the size distribution of tumors among women aged over 40. Their conclusions? \u201cWomen were more likely to have breast cancer that was overdiagnosed than to have earlier detection of a tumor that was destined to become large. The reduction in mortality after implementation of screening mammography was predominantly the result of improved systemic therapy.\u201d<\/p>\n<p>Given the implications of these conclusions on the field of screening mammography, the response has been swift. In\u00a0<a href=\"http:\/\/www.auntminnie.com\/index.aspx?Sec=sup&amp;Sub=wom&amp;Pag=dis&amp;ItemId=115330\" target=\"_blank\">a careful critique<\/a>\u00a0published by\u00a0<a href=\"http:\/\/auntminnie.com\/\">AuntMinnie.com<\/a>, Daniel Kopans \u2013 one of the world\u2019s foremost authorities on the benefits of screening \u2013 has provided a stinging rebuttal of the <em>NEJM<\/em> paper. He commented that the current article is little more than a rehash of\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1206809#t=article\" target=\"_blank\">Welch\u2019s 2012 paper<\/a>\u00a0that falsely claimed massive \u2018overdiagnosis\u2019 of breast cancer.<\/p>\n<p>As Kopans highlighted, a major problem with the two papers by Welch (seen below left) is that he and his co-authors \u201cguessed\u201d what the incidence of breast cancer would have been had screening not been introduced in the mid-1980s. In 2012 they assumed a rate pf 0.25% per annum while in the most recent paper they claimed there was no underlying increase in incidence. Kopans\u00a0<a href=\"http:\/\/www.auntminnie.com\/index.aspx?Sec=sup&amp;Sub=wom&amp;Pag=dis&amp;ItemId=115330\" target=\"_blank\">pointed out<\/a>\u00a0that the incidence has been increasing steadily by 1% per annum since 1940 as shown by the highly respected\u00a0<a href=\"http:\/\/www.ct.gov\/dph\/cwp\/view.asp?a=3129&amp;Q=574604&amp;dphNav=%7C&amp;dphNav_GID=2196\" target=\"_blank\">Connecticut Tumor Registry<\/a>. Since Welch\u2019s results relied on extrapolation, a faulty underlying assumption led to the finding of \u2018overdiagnosis.\u2019<\/p>\n<p><a href=\"https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Gilbert_Welch.jpg\" target=\"_blank\"><img decoding=\"async\" class=\"alignleft wp-image-5771 size-full\" src=\"https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Gilbert_Welch.jpg\" width=\"250\" srcset=\"https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Gilbert_Welch.jpg 546w, https:\/\/www.caperay.com\/blog\/wp-content\/uploads\/2016\/10\/Gilbert_Welch-200x300.jpg 200w\" sizes=\"(max-width: 546px) 100vw, 546px\" \/><\/a>The American College of Radiology has also weighed in,\u00a0<a href=\"http:\/\/www.auntminnie.com\/index.aspx?Sec=sup&amp;Sub=wom&amp;Pag=dis&amp;ItemId=115331\" target=\"_blank\">commenting<\/a>: \u201cThe data do not support the authors\u2019 conclusion that improved therapy is more key to breast cancer survival than mammography screening.\u201d As seen above right (\u00a9 <em>NEJM<\/em>), tumor size distribution changed with the introduction of screening in the mid-1980s, leading Welch and co-authors to speculate that many of the smaller tumors led to \u2018overdiagnosis.\u2019<\/p>\n<p>Kopans\u00a0<a href=\"http:\/\/www.auntminnie.com\/index.aspx?Sec=sup&amp;Sub=wom&amp;Pag=dis&amp;ItemId=115330\" target=\"_blank\">expressed concern<\/a>\u00a0that a prestigious journal such as the <em>NEJM<\/em> would publish papers falsely disparaging the benefits of screening by allowing faulty assumptions to be used. \u201cClearly peer review has failed at the <em>NEJM<\/em>\u201d he said. \u201cWhat should not be missed is that if actual data are used, and not guesses, this paper confirms the major decline in breast cancer deaths since 1990 is predominantly due to earlier detection from screening.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The New England Journal of Medicine (NEJM) yesterday\u00a0published a paper\u00a0entitled \u201cBreast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.\u201d Lead author [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_s2mail":"yes","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[1],"tags":[16,27,39,54,58,80,90,95],"class_list":["post-5765","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-breast_cancer","tag-controversy","tag-epidemiology","tag-journal_article","tag-mammography","tag-screening","tag-survey","tag-tumour"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 5.0.0.1 - aioseo.com -->\n\t<meta name=\"description\" content=\"The New England Journal of Medicine (NEJM) yesterday published a paper entitled \u201cBreast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.\u201d Lead author Gilbert Welch from Dartmouth and his co-authors analysed 37 years of data from the Surveillance, Epidemiology and End Results (SEER) programme to calculate the size distribution of tumors among women aged over 40. Their conclusions?\" \/>\n\t<meta name=\"robots\" content=\"max-image-preview:large\" \/>\n\t<meta name=\"author\" content=\"admin\"\/>\n\t<link rel=\"canonical\" href=\"https:\/\/www.caperay.com\/blog\/overdiagnosis-in-the-spotlight-again\/\" \/>\n\t<meta name=\"generator\" content=\"All in One SEO (AIOSEO) 5.0.0.1\" \/>\n\t\t<meta property=\"og:locale\" content=\"en_US\" \/>\n\t\t<meta property=\"og:site_name\" content=\"CapeRay blog - CapeRay news stories and articles about breast cancer diagnosis\" \/>\n\t\t<meta property=\"og:type\" content=\"article\" \/>\n\t\t<meta property=\"og:title\" content=\"\u2018Overdiagnosis\u2019 in the Spotlight \u2013 Again - CapeRay blog\" \/>\n\t\t<meta property=\"og:description\" content=\"The New England Journal of Medicine (NEJM) yesterday published a paper entitled \u201cBreast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.\u201d Lead author Gilbert Welch from Dartmouth and his co-authors analysed 37 years of data from the Surveillance, Epidemiology and End Results (SEER) programme to calculate the size distribution of tumors among women aged over 40. 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Their conclusions?","inLanguage":"en-US","isPartOf":{"@id":"https:\/\/www.caperay.com\/blog\/#website"},"breadcrumb":{"@id":"https:\/\/www.caperay.com\/blog\/overdiagnosis-in-the-spotlight-again\/#breadcrumblist"},"author":{"@id":"https:\/\/www.caperay.com\/blog\/author\/admin\/#author"},"creator":{"@id":"https:\/\/www.caperay.com\/blog\/author\/admin\/#author"},"datePublished":"2016-10-14T15:19:46+02:00","dateModified":"2016-10-14T20:36:13+02:00"},{"@type":"WebSite","@id":"https:\/\/www.caperay.com\/blog\/#website","url":"https:\/\/www.caperay.com\/blog\/","name":"CapeRay blog","description":"CapeRay news stories and articles about breast cancer diagnosis","inLanguage":"en-US","publisher":{"@id":"https:\/\/www.caperay.com\/blog\/#organization"}}]},"og:locale":"en_US","og:site_name":"CapeRay blog - CapeRay news stories and articles about breast cancer diagnosis","og:type":"article","og:title":"\u2018Overdiagnosis\u2019 in the Spotlight \u2013 Again - CapeRay blog","og:description":"The New England Journal of Medicine (NEJM) yesterday published a paper entitled \u201cBreast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.\u201d Lead author Gilbert Welch from Dartmouth and his co-authors analysed 37 years of data from the Surveillance, Epidemiology and End Results (SEER) programme to calculate the size distribution of tumors among women aged over 40. 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Their conclusions?"},"aioseo_meta_data":{"post_id":"5765","title":null,"description":null,"keywords":null,"keyphrases":null,"focus_keyword":null,"additional_keywords":null,"truseo_locale":null,"primary_term":null,"canonical_url":null,"og_title":null,"og_description":null,"og_object_type":"default","og_image_type":"default","og_image_custom_url":null,"og_image_custom_fields":null,"og_image_url":null,"og_image_width":null,"og_image_height":null,"og_video":null,"og_custom_url":null,"og_article_section":null,"og_article_tags":null,"twitter_use_og":false,"twitter_card":"default","twitter_image_type":"default","twitter_image_custom_url":null,"twitter_image_custom_fields":null,"twitter_image_url":null,"twitter_title":null,"twitter_description":null,"schema_type":"default","schema_type_options":null,"schema":{"blockGraphs":[],"customGraphs":[],"default":{"data":{"Article":[],"Course":[],"Dataset":[],"FAQPage":[],"Movie":[],"Person":[],"Product":[],"ProductReview":[],"Car":[],"Recipe":[],"Service":[],"SoftwareApplication":[],"WebPage":[]},"graphName":"","isEnabled":true},"graphs":[]},"pillar_content":false,"robots_default":true,"robots_noindex":false,"robots_noarchive":false,"robots_nosnippet":false,"robots_nofollow":false,"robots_noimageindex":false,"robots_noodp":false,"robots_notranslate":false,"robots_max_snippet":null,"robots_max_videopreview":null,"robots_max_imagepreview":"large","priority":null,"frequency":null,"local_seo":null,"limit_modified_date":false,"ai":null,"breadcrumb_settings":null,"seo_analyzer_scan_date":null,"created":"2026-08-25 01:14:03","updated":"2026-08-25 01:14:03"},"aioseo_breadcrumb":"<div class=\"aioseo-breadcrumbs\"><span class=\"aioseo-breadcrumb\">\n\t\t\t<a href=\"https:\/\/www.caperay.com\/blog\" title=\"Home\">Home<\/a>\n\t\t<\/span><span class=\"aioseo-breadcrumb-separator\">&raquo;<\/span><span class=\"aioseo-breadcrumb\">\n\t\t\t<a href=\"https:\/\/www.caperay.com\/blog\/category\/uncategorized\/\" title=\"Uncategorized\">Uncategorized<\/a>\n\t\t<\/span><span class=\"aioseo-breadcrumb-separator\">&raquo;<\/span><span class=\"aioseo-breadcrumb\">\n\t\t\t\u2018Overdiagnosis\u2019 in the Spotlight \u2013 Again\n\t\t<\/span><\/div>","aioseo_breadcrumb_json":[{"label":"Home","link":"https:\/\/www.caperay.com\/blog"},{"label":"Uncategorized","link":"https:\/\/www.caperay.com\/blog\/category\/uncategorized\/"},{"label":"&#8216;Overdiagnosis&#8217; in the Spotlight \u2013 Again","link":"https:\/\/www.caperay.com\/blog\/overdiagnosis-in-the-spotlight-again\/"}],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/posts\/5765","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/comments?post=5765"}],"version-history":[{"count":7,"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/posts\/5765\/revisions"}],"predecessor-version":[{"id":5774,"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/posts\/5765\/revisions\/5774"}],"wp:attachment":[{"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/media?parent=5765"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/categories?post=5765"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.caperay.com\/blog\/wp-json\/wp\/v2\/tags?post=5765"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}