Josep M. Borràs
Scientific coordinator of the National Health System Cancer Strategy, director of the Catalan Oncology Plan and Professor of Preventive Medicine and Public Health at the University of Barcelona
The article is very interesting and provides necessary data to discuss a hot topic in screening: the issue of overdiagnosis and overtreatment. The design of the study is very good and ingenious. It is really interesting to see how, based on the data observed in screening tests in women over 70 years of age in the USA, the study compares real incidence data between women who were screened and those who were not screened. The statistical method is appropriate, especially for adjusting results in people over 70 years of age.
The conclusion is relevant: there is overdiagnosis and it can be quantified. Now, as the editorial says, it is important to know that screening should be done according to quality criteria and on a regular basis. Even in this case, there may still be overdiagnosis.
The discussion of overdiagnosis is especially relevant among women between 70 and 74 years of age, who are beginning to be invited to continue screening when they reach 70 years of age in several Autonomous Communities in Spain, as proposed by the scientific committee of the European Union. Therefore, my conclusion is that this screening should be extended as long as its evaluation can be guaranteed in the framework of a population screening programme.
This article provides data on the risk of overdiagnosis and allows a proper assessment of the balance of benefits and risks in this area.