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Breast Cancer Screening
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 Unpublished letters cannot be returned.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.
IN RESPONSE:
Dr. Kopans raises a familiar question: Why do people refer to age 50 as a significant age for breast cancer screening when it has no biological significance? The answer is that this age is a proxy for the occurrence of natural menopause. Ideally, the clinical trials of breast cancer screening would have reported their results according to menopausal status at the time of screening but, to my knowledge, they did not. Dr. Kopans points out that there are no data that indicate a relationship between screening results and menopause. The reader should note that “no data” does not mean “no relationship.” Until someone tests the hypothesis that results differ by menopausal status, we will have to use age 50 as a proxy for menopause.
My editorial asserted that when the Canadian study (1) and the meta-analysis of the Swedish studies (2) counted breast cancer deaths in the same way, both showed a small effect of screening, with 95% CIs that included no effect. Dr. Kopans ends his letter by saying that we should inform women that screening is effective beginning at age 40, but he does not present evidence to contradict my conclusion and support his own.
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.
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