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Nonmammographic Screening for Breast Cancer
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To the Editor: The Editorial by Dr Kuhl1 advocated breast MRI and other additional screening for breast cancer. However, for younger women there is an important issue of whether the average absolute benefit of any breast cancer screening is worth the harms and the opportunity costs.
Kuhl dismissed the first major harm inherent in screening healthy women: false-positive evaluation and biopsy-related anxiety. Screening advocates should help quantify this psychological distress and the opportunity costs for use in cost-effectiveness analyses.
Moreover, Kuhl did not discuss the second major potential screening harm: ductal carcinoma in situ overdiagnosis. This extreme form of length bias (in which screening preferentially identifies slower growing tumors without survival benefit) is one reason why the use of surrogate end points to replace randomized trials is not valid.2
Screening prevents some breast cancer deaths but not breast cancer. There is a 14.4% lifetime development risk for in situ and . . . [Full Text of this Article]
John D. Keen, MD, MBA
jkeen@ccbhs.org
Stroger Hospital of Cook County
Chicago, Illinois
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