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The Breast Cancer Screening Controversy Continues
- Wende W. Logan-Young, MD;
- Nancy Yanes Hoffmann, MD; and
- Joyce Janus, MD
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TO THE EDITOR:
You are to be congratulated for reminding internists of their obligation to teach and perform a competent breast examination on every female patient [1]. Nevertheless, your recommendations, based on the Canadian study [2], to abolish screening mammography for women under the age of 50 render a grievous disservice to such women. The Canadian Study's obviously inferior mammograms were incapable of discovering early breast cancer and thus could not improve chances of survival.
In 1980, the University of Toronto asked one of us to serve as a mammographic consultant for this study. After a few months of never being allowed to see the mammograms, she felt compelled to resign. Dr. Edward Sickles of the University of California School of Medicine and Dr. Stephen Feig of Jefferson Medical College, both world-renowned mammographers, resigned for the same reason. An offer from our clinic to train Canadian radiologists and mammographic technologists to perform and interpret mammograms correctly was refused.
The Canadian study's inability to reduce breast cancer mortality in women 50 to 60 years of age contrasts markedly with the significant HIP [3], Swedish [4], and Dutch [5] mortality reductions achieved with excellent mammographic technique. Furthermore, the Canadian study presented no proof that high quality physical examination [1] increased the survival rate, because it did not include any control group of similar women not undergoing a physical examination.
The editorial cites the Swedish study by Tabar and colleagues [4] but does not mention the reduced mortality of 31% in women 40 to 74 years of age. Although this trial is the best on record, its findings remain skewed by major deficiencies: It used one mammographic view only, and its initial mammographic interval was 30 months, longer than the estimated lead time for women 40 to 49 years of age.
In our opinion, physicians owe it to their female patients over 40 years of age to fight breast cancer aggressively by examining these women mammographically and clinically every year.
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.
- Copyright 2004 by the American College of Physicians
