Measures for Reducing Over-diagnosis in Breast Cancer Screening

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  • Morimoto Tadaoki
    Professor Emeritus, The University of Tokushima
  • Kasahara Yoshio
    Department of Surgery, Fukui Saiseikai Hospital
  • Tsunoda Hiroko
    Department of Radiology, St. Luke's International Hospital
  • Tangoku Akira
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School

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Other Title
  • 乳癌検診の過剰診断について
  • ―避けるための対応策―

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The US Preventive Services Task Force (USPSTF) assesses the efficacy of breast cancer screening by the sum of its benefits and harms. Randomized clinical trials (RCTs) of breast cancer screening in Europe and the US have shown 15～32% mortality reduction in the 40～69-year age group. As well as reduction of over-diagnosis, quality control of screening is important for reducing the rates of false positivity, false negativity, and recall. Over-diagnosis in cancer screening has become a hot topic in Europe and the US. 'Over-diagnosis' means the detection and diagnosis of cancers that do not affect the life of the patient. Over-diagnosis is most common during screening for neuroblastoma, prostate cancer, lung cancer and thyroid cancer. Data from Europe and the US indicate that about 10～30% of breast cancers are over-diagnosed by screening. Even in early-stage breast cancer, some lesions, such as non-invasive cancers, can be over-diagnosed. The mammography screening rate in Japan is as low as 20～30%, compared with 70～80% in Europe and the US. In Japan, in addition to emphasizing the harm of screening, it is necessary to improve the participation rate in quality-controlled mammography screening (to 50% or more). In particular, population-based screening should conform to guidelines that are evidence-based for mortality reduction. We also need to perform clinicopathological studies of breast cancers that may be over-diagnosed, and compile data on over-diagnosis. For prevention of over-diagnosis, we need to avoid excessive detailed examinations and over-treatment, and should also consider establishing observation (watchful waiting) groups. There is also a need for joint decision-making between examinees and medical institutions regarding the harm of screening. Treatment of breast cancers that are suspected to be over-diagnosed should be undertaken on the basis of an informed decision by the examinee.

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