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In both the medical literature and lay press, a flurry of controversy has arisen surrounding the treatment and, more specifically, the potential overtreatment of ductal carcinoma in situ (DCIS). Since the advent of population-based screening mammography in the mid-1980s, the incidence of DCIS has increased more than 8-fold, with DCIS now accounting for nearly 22 % of new breast cancer diagnoses.1,2 Since 1990, death rates from breast cancer in the United States have decreased by approximately 34%,1,3 a favorable outcome that has been attributed to the combination of increased screening mammography and improved adjuvant therapy.4 However, despite the steady increase in DCIS detection and treatment in the 1990s, the subsequent incidence of invasive breast cancers did not proportionately decrease.5 Invasive breast cancer incidence among women older than 50 years declined sharply between 2002 and 2003 but has since stabilized, a finding that could reflect a reduced pool of prevalent breast cancer cases as a result of widespread screening, but also could relate to the decreased use of hormone replacement therapy or trends in mammography screening rates that peaked in 2000.1 Approximately 1 in every 1300 screening mammography examinations leads t