Persistent Untreated Screening-Detected Breast Cancer: An Argument Against Delaying Screening or Increasing the Interval Between Screenings

Published:April 27, 2017DOI:



      The aim of this study was to investigate the natural history of untreated screen-detected breast cancer.


      A prospective cohort survey of Society of Breast Imaging fellows concerning the appearance on subsequent mammography of untreated breast cancer detected on screening mammography was conducted.


      A representative sample of the 108 actively practicing Society of Breast Imaging fellows (n = 42 [39%]) participated, each reporting outcomes data from his or her entire screening mammography practice. Among all practices, 25,281 screen-detected invasive breast cancers and 9,360 cases of screen-detected ductal carcinoma in situ were reported over the past 10 years. Among these cancers, there were 240 cases of untreated invasive breast cancer and 239 cases of untreated ductal carcinoma in situ, among which zero were reported to have spontaneously disappeared or regressed at next mammography.


      Among 479 untreated breast cancers detected on screening mammography, none spontaneously disappeared or regressed. An unknown percentage of these cancers represent overdiagnosis, but because all untreated screen-detected cancers were visible and suspicious for malignancy at next mammographic examination, delaying the onset of screening or increasing the interval between screenings should not reduce the frequency of overdiagnosis.

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      Linked Article

      • Breast Cancer Screening Frequency and Overdiagnosis
        Journal of the American College of RadiologyVol. 14Issue 12
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          In their interesting article, Arleo et al [1] observe that in a series of 479 untreated breast cancers (1.4% of screening-detected cases reported by 42 experienced imaging specialists), none spontaneously disappeared or regressed. On the basis of this finding, they argue that there is no point in delaying the initiation of screening until after 40 years of age or in providing less frequent (biennial) tests because potentially overdiagnosed cases left undetected (and consequently untreated) by a less-than-intensive screening protocol would still be detected later when the time of screening eventually comes.
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