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Laura Esserman, MD, MBA; Yiwey Shieh, AB; Ian Thompson, MD

JAMA. 2009;302(15):1685-1692.

After 20 years of screening for breast and prostate cancer, several observations can be made. First, the incidence of these cancers increased after the introduction of screening but has never returned to prescreening levels. Second, the increase in the relative fraction of early stage cancers has increased. Third, the incidence of regional cancers has not decreased at a commensurate rate. One possible explanation is that screening may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers and therefore not resulting in the anticipated reduction in cancer mortality. To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered.

Author Affiliations: Department of Surgery and Radiology (Dr Esserman) and School of Medicine (Mr Shieh), University of California, San Francisco, and Department of Urology, University of Texas Health Science Center, San Antonio (Dr Thompson).

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