To the Editor: Epidemiologists have long argued that neither stage at diagnosis nor survival since diagnosis can demonstrate the beneficial effects of a screening technology on cancer mortality. The only reliable guide is a change in the overall age-adjusted mortality rate. In light of this, the absence of any mention of changes in recent age-adjusted mortality rates in the United States for the cancers of interest in the article by Dr Esserman and colleagues1 on cancer screening is surprising.
Paneth N, Vande Woude G, Kort E. Screening and Detection of Breast Cancer and Prostate Cancer. JAMA. 2010;303(11):1032-1034. doi:10.1001/jama.2010.274