Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Schwartz and colleagues1 suggested that cancer screening may lead to unnecessary
cancer diagnosis and treatment. For instance, they reported a "false positive"
rate of 30% for Papanicolaou tests and 35% for mammography. I would be interested
in more information about how the authors obtained these data, and the populations
to which they refer. In any event, screening tests are not designed to provide
a final diagnosis, but to identify persons who require further studies. Schwartz
et al did mention possible adverse effects of screening examinations, but
they omitted the likely benefits, such as early diagnosis allowing more cures
and less-mutilating treatments. Like cervical cancer, mortality for breast
cancer has been declining in the last several years.2 I
believe that screening mammography has contributed significantly to the increased
survival. Although Schwartz et al appear skeptical about the value of screening
tests, they do not propose other means for detecting curable malignancies
or their precursors.
Nyirjesy I. The Public's Enthusiasm for Cancer Screening. JAMA. 2004;291(15):1835. doi:10.1001/jama.291.15.1835-b