Letters: Breast screening frequency debated
So the Department of Health and Human Services has concluded that mammograms are not necessary until age 50 for most women, and then they should have them only every other year ["Needless tests hurt fiscal health," Editorial, Feb. 12].
Has the federal government also studied the anxiety women experience when they get that dreadful diagnosis of breast cancer, and their relief from successful treatment because cancer was detected early? I would venture to say their relief more than makes up for the anxiety of a false-positive you refer to.
You make light of the fact that when an independent panel appointed by Health and Human Services reached its conclusion, it was lambasted because "death panels" were being discussed in the context of health care reform. In fact, this is only one "death panel" report. As your editorial admits, this same panel wants to reduce blood tests to screen for prostate cancer. So, where does the definition of unnecessary testing end?
Natalie Allegato, Hauppauge
One has to wonder why peer review did not raise questions about the potential major selection biases in this study. It was not a prospective randomized trial. It was a retrospective analysis of data from the Breast Cancer Surveillance Consortium linked to Medicare claims. The authors compared cancers among women who underwent annual mammography to women who were screened every two years.
The problem is that these are likely distinctly different populations. The authors provide no information as to why some women were screened annually and others were screened every two years. It is likely that the women screened annually were considered to be at higher risk of developing breast cancer.
One fundamental question is not even addressed: The authors did not provide the actual tumor sizes in the groups. If the groups are comparable, which is unlikely, these results suggest that breast cancers did not grow over the extra year among women in this trial. Otherwise, the delay in screening of one year should have been reflected in larger cancers. Did the cancers stop growing and wait to be detected?
We suspect that cancers do grow, and these results are based on biases introduced by the study design.
Dr. Geraldine McGinty, Garden City
Dr. Daniel B. Kopans, Boston
Editor's note: The writers are, respectively, a partner with NRAD Medical Associates and a professor of radiology at Harvard Medical School.