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Napoli, Maryann

AJN The American Journal of Nursing: August 2002 - Volume 102 - Issue 8 - p 14

New York, NY

The News article, “What's the Verdict on Mammograms?” (May), describes the controversy surrounding research that raised questions about the ability of mammographic screening to save lives. I was puzzled by your conclusion, that clinicians should “continue to do what they've always done: recommend that their female patients older than 40 have regular mammograms.”

That's a strange message, given that the researchers-in both their metaanalysis and subsequent research letter, published in the Lancet 1,2-contradicted the prevailing belief that screening leads to less drastic treatment (the pooled results of the seven mammography trials they studied showed there were 20% more mastectomies performed among the women who received screening mammograms compared with those who didn't).

In addition, your News article gave only brief mention of another danger: the overtreatment of nonpalpable tumors detected with mammography, which now represent 20% of all new cases of breast cancer.3 According to the information presented at conferences I've attended and to conversations with breast cancer advocates, these cancers are usually treated with either six weeks of radiation therapy or mastectomy, although the majority of them would never have progressed to invasive breast cancer.

Perhaps a more appropriate conclusion would have been a recommendation that clinicians warn women of the high rate of overtreatment associated with mammographic screening.

Maryann Napoli

New York, NY

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1. Olsen O, Gøtzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet 2001;358(9290):1340-2.
2. Gøtzsche PC, Olsen O. Is screening for breast cancer with mammography justifiable? Lancet 2000;355(9198):129-34.
3. American Cancer Society. Cancer facts and figures 2002.
© 2002 Lippincott Williams & Wilkins, Inc.