Alfred O. Berg, MD, MPH; Janet Allan, PhD, RN, CS; Steven Woolf, MD, MPH
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 Unpublished letters cannot be returned.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.
Berg AO, Allan J, Woolf S. The Mammography Dilemma. Ann Intern Med. 2003;138:770-771. doi: 10.7326/0003-4819-138-9-200305060-00023
Download citation file:
Published: Ann Intern Med. 2003;138(9):770-771.
TO THE EDITOR:
The editorial by Dr. Steven Goodman (1) on the U.S. Preventive Task Force (USPSTF) recommendations for breast cancer screening (2) made important observations on the difficulties in crafting evidence-based recommendations regarding mammography. The members of the USPSTF share Goodman's belief that no amount of rigor in critiquing evidence will extinguish the mammography debate or completely eliminate the subjectivity of grading evidence, but we take exception to three points.
First, Goodman asserted that the USPSTF was inattentive to the harms of mammography. The full USPSTF recommendation and rationale statement, only part of which was published in Annals, more thoroughly discusses the potential harms of screening (3). The USPSTF considers the harms of screening in all of its assessments, highlighting the anxiety, labeling effects, false-positive results, and complications induced by the cascade of tests and the treatments that they propagate. Our mammography report discussed the potential for mammography to cause anxiety, unnecessary biopsies, and the detection and treatment of cancer of uncertain clinical significance (for example, ductal carcinoma in situ). In addition, our recommendation noted the balance between benefits and harms that becomes steadily more favorable as women get older. Ductal carcinoma in situ accounts for a large and growing proportion of screening-detected cancer. To the extent that treatment of ductal carcinoma in situ constitutes overtreatment, screening mammography would be expected to induce unnecessary surgery, although we did not find good evidence to confirm this suspicion. The best evidence of harms relates to false-positive mammography and biopsy results.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only