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April 21, 2004

The Public's Enthusiasm for Cancer Screening—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(15):1835. doi:10.1001/jama.291.15.1836-b

In Reply: Drs Shenson and Alderman suggest there is a mismatch between the strong public enthusiasm for cancer screening we reported and a low observed screening rate reported by others. The dismal statistic they cite—"fewer than 12% of US women aged 50 years or older are up to date with recommended preventive services"—is misleading. It refers to the proportion of women up to date on all of 6 preventive services (colorectal, cervical, and breast cancer screening; cholesterol testing; flu and pneumonia vaccinations). In fact, according to year 2000 data from the US Centers for Disease Control and Prevention, median compliance with mammography and Papanicolaou testing recommendations were 76% and 87%, respectively, across the 50 States (rates of colorectal cancer were substantially lower, with a median 31% of women 50 and older up to date).1 While we agree that facilitating access to screening for those who want it is an important goal, a more basic challenge is helping people decide whether to be screened in the first place. A good point at which to start would be to help people develop an accurate idea of the health risks they face, the extent to which screening can reduce those risks, and a realistic sense of the potential downsides of screening.

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