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To the Editor: In their discussion of pseudodisease caused by growth of medical care, Drs Fisher and Welch¹ highlight the largely unexplored area of disagreement in pathologists' diagnoses of early malignancy and malignant precursors. This diagnostic disagreement is a red flag for the identification of pathogenic pathology reports. However, if the associated morbidity is to be prevented, it is important that we understand the pathogenesis of the resulting pseudodisease.

An important cause of neoplastic pseudodisease is the flawed classification system. Confirming the thesis of Fisher and Welch, these flawed systems become increasingly virulent when used to guide the interpretation of biopsies from larger and larger numbers of clinically healthy people, especially when these people will be offered aggressive treatment options for a "positive" biopsy result. Examples of the impact of a flawed classification system are found among the 500,000 to 1 million breast biopsies performed each year in the United . . . [Full Text of this Article]