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April 6, 1994

The Use of Mammography for Screening

Author Affiliations

Massachusetts General Hospital Boston

JAMA. 1994;271(13):982. doi:10.1001/jama.1994.03510370034020

To the Editor.  —There is a trend on the part of the epidemiologic community to try to find reasons to withdraw support for screening women aged 40 to 49 years for breast cancer and a disturbing lack of balanced scientific analysis. This trend is reflected in the paper by Dr Kerlikowske and colleagues.1 Their conclusions are biased and certainly more sweeping than the data justify, and the quoted historical data concerning screening are factually incorrect.The meta-analysis cited by the authors used out-of-date numbers. Fletcher et al2 reported that the mortality benefit in five of the eight randomized, controlled trials for women aged 40 to 49 years ranges from 22% in the Edinburgh study3 to 49% in the Malmo trial,4 not the 13% to 23% cited by Kerlikowske et al. It is specious to suggest that these results are "nonsignificant" since the trials were not designed

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