The Law of Unintended Consequences: Digital Mammography and a Case for Overdiagnosis

Background: Pathologic entities of the breast that fall into the "high-risk" category include atypical ductal hyperplasia (ADH) and lobular neoplasia (LN). When diagnosed on core needle biopsy, these lesions are generally surgically excised, but the potential behavior of these lesions is poorly understood. Although some studies have established ADH as a precursor to ductal carcinoma in situ and ultimately invasive carcinoma, reliable variables to determine which lesions will progress and which will not are not known. LN is considered a risk factor for the development of breast cancer, but not necessarily a precursor to malignancy. Studies show that digital mammography is better at detecting calcifications than film-screen mammography. Objective: To determine if the wide adoption of digital mammography has resulted in greater diagnosis of ADH and LN. Methods: Over a 6-year retrospective period, a database was searched to identify patients who were diagnosed with ADH, LN, or flat epith more...