To the Editor One of the major conclusions of the recent article by Drs Pace and Keating1 was that “The net benefit of screening depends greatly on baseline breast cancer risk, which should be incorporated into screening decisions.” This seems logical, but I do not believe there is evidence that it is true.
The primary reason screening mammography is so controversial is because the most important outcome is mortality, and only 8 old randomized trials have used mortality as an outcome. Recent trials testing new modalities such as ultrasound or magnetic resonance imaging in high-risk groups have used rate of breast cancer detection as an outcome.2,3 These trials cannot distinguish between detection of potentially lethal cancers and overdiagnosis of indolent, harmless cancers.
Lannin DR. Risk and Benefits of Screening Mammography. JAMA. 2014;312(6):649. doi:10.1001/jama.2014.7658