Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Woloshin S, Schwartz LM, Welch HG. The Public's Enthusiasm for Cancer Screening—Reply. JAMA. 2004;291(15):1835. doi:10.1001/jama.291.15.1836-b