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March 17, 2010

Screening and Detection of Breast Cancer and Prostate Cancer

JAMA. 2010;303(11):1032-1034. doi:10.1001/jama.2010.275

To the Editor: Dr Esserman and colleagues1 provided lucid and compelling reasons to challenge the current methods of screening for prostate and breast cancers and correctly concluded that “tumor biology dictates and trumps stage, so the basic assumption . . . that finding and treating early stage disease will prevent late stage or metastatic disease may not always be correct.” In the examples cited, early detection and treatment rarely prevent the development of metastatic disease, as evidenced by large screening studies in both prostate and breast cancer.2 However, hypothetical tumor C (one benefiting from screening) in Figure 3 is misleading and, as interpreted, will do little to change the status quo of inappropriately treating indolent cancers that are still “localized to organ.”

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