 Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
LETTER
Mammographic Screening for Women 40 to 49 Years of Age
Ismail Jatoi, MD, PhD
15 October 1995 | Volume 123 Issue 8 | Pages 634-635
TO THE EDITOR:
The National Cancer Institute recommends screening with clinical breast examination rather than mammography for women between the ages of 40 and 49 years, a policy that Drs. Sickles and Kopans [1] criticize as "scientifically inconsistent but politically expedient." In fact, no evidence suggests that mammographic screening is superior to breast examination alone in reducing breast cancer-related mortality for any age group; in addition, screening mammography is associated with more adverse effects. For example, although the Health Insurance Plan study [2] showed a benefit from breast cancer screening, women in the study group were screened by breast examination and mammography, and more than half of the detected cancers were found by breast examination alone. Most other prospective trials have compared mammographic screening alone with no screening and have found that screening reduces mortality in women older than 50 years. The Canadian National Breast Screening Study, however, compared screening with mammography and breast examination with breast examination alone for women older than 50 years of age [3]. No difference in mortality was noted between the two arms of the study, suggesting that mammography does not reduce mortality beyond the benefits of breast examination alone. Mammographic screening has harmful effects, including lead time, overdiagnosis, a high incidence of false-positive results, radiation exposure, and high cost [4, 5]. Although no evidence suggests that screening with either mammography or breast examination reduces breast cancer-related mortality in women younger than 50 years, breast examination is a more acceptable option for such women because it causes less harm.
|
Author and Article Information
|
|---|
Brooke Army Medical Center; Fort Sam Houston, TX 78234
1. Sickles EA, Kopans DB. Mammographic screening for women aged 40 to 49 years: the primary care practitioners dilemma. Ann Intern Med. 1995; 122:534-8.
2. Shapiro S, Venet W, Strax P, Venet L, Roeser R. Ten- to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst. 1982; 69:349-55.
3. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: breast cancer detection and death rates among women aged 50-59 years. Can Med Assoc J. 1992; 147:1477-87.
4. Jatoi I, Baum M. American and European recommendations for screening mammography in younger women: a cultural divide? BMJ. 1993; 307:1481-3.
5. Jatoi I, Baum M. Mammographically detected ductal carcinomas in situ: are we overdiagnosing breast cancer? [Editorial]. Surgery. 1995; 118:118-20.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Related articles in Annals:
-
Editorials
Screening Mammography in Women Younger than 50 Years of Age
Harold C. Sox
- Annals 1995 122: 550-552.
[Full Text]
Top
Author & Article Info
References