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To the Editor: In their study of the use of ultrasound and mammography in breast cancer detection in a high-risk population, Dr Berg and colleagues¹ stated that trials to look at actual improvement in survival "are costly . . . and . . . not practical under all contexts." In contrast, I believe that it may be more costly not to do those trials. In their absence, the costs of ultrasound use and its attendant false positives will add expense to the health care system without sufficient evidence of net benefit.

Earlier diagnosis does not invariably mean lower death rates because there can be detection bias and lead time bias. Moreover, based on past experience with new technology, research evaluating the use of a test in a high-risk population can be expected to result in its use in lower-risk populations, further decreasing the potential benefit while increasing the costs. With health care coverage being inversely related to costs,² . . . [Full Text of this Article]

B. Dale Magee, MD, MS
dmagee@townisp.com
Shrewsbury, Massachusetts

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