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• W4232746435 abstract "Dr. Jatoi offers a novel explanation of the survival benefits observed in breast carcinoma screening trials. Unexplained by this hypothesis is the 30% reduction in breast carcinoma deaths that persists with prolonged follow-up. Furthermore, the survival curves continue to separate as the length of follow-up increases.1 In any event, the commends do not address our major finding that women older than and younger than 50 years with mammographically detected breast carcinomas have the same prognosis, whereas tumors detected by clinical examination in women age <50 years are associated with a much worse prognosis.2 Our study focused on patients with early stage breast carcinoma treated with breast-conserving therapy at our institution. These patients represented a snapshot of the patients with early stage breast carcinoma whom we are currently encountering in our clinical practices. Among them, if the tumors were mammographically detected there was no difference between women age <50 years or age ≥50 years. There was no significant difference in tumor size, axillary lymph node involvement, tumor grade, or disease-free survival. Hence, if mammograms benefit women age ≥50 years, these same benefits appear to be applicable to women age <50 years. Importantly, in women age <50 years the tumors detected clinically are larger than in women age ≥50 years, possibly because they are growing faster and because clinical examination is less sensitive in the younger women, the breasts being denser and more fibrocystic. Thus far, the benefit in recurrence-free survival was greater for women age <50 years than for those age ≥50 years. At 5 years, 90% of women age <50 years were free of recurrence if their tumors were mammographically detected, compared with 77% if the tumor was detected by palpation; among women age ≥50 years, 92% with mammographically detected tumors were free of recurrence, compared with 87% if the tumor was detected by palpation. For the patient the risks associated with mammographically are low. The benefits of reduced mortality have been shown to outweigh the risk of radiation exposure.3, 4 False-positive do occur5 and result in increased cost, both emotional and financial, because of the need for additional diagnostic procedures, but surely this price is far less than delays in the diagnosis of breast carcinomas resulting in the detection of larger, axillary lymph node positive tumors that are less curable. Furthermore, a recent study addressed the cost-effectiveness of screening mammography starting at age 40 years and showed that the cost-effectiveness expressed as marginal cost per year of life saved was within the range of other generally acceptable diagnostic and therapeutic medical procedures.6 Ruth Heimann M.D. Ph.D.*, Jeffrey Bradley M.D.*, Samuel Hellman M.D.*" @default.
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• W4232746435 date "1998-11-01" @default.
• W4232746435 modified "2023-09-23" @default.
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• W4232746435 doi "https://doi.org/10.1002/(sici)1097-0142(19981101)83:9<2046::aid-cncr26>3.3.co;2-k" @default.
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