To the Editor.
—The article by Dr Kattlove and colleagues1 presents a basic benefit package for detection and treatment of early breast cancer. I believe this concept has many flaws. Implementation of this package takes the diagnosis and treatment of breast cancer out of the hands of the patient and her physician and transfers it into the hands of third-party payers.I cannot agree with the authors' denying screening mammography for women younger than 49 years. Early-age screening mammography detects breast tumors that are small. This leads to a more favorable prognosis for the breast cancer patient.Breast-conserving surgery for early cancer of the breast requires adjunct radiotherapy. Friedman2 concluded from studying pathological tissues from 100 women who received radiation therapy that carcinoma of the breast cannot be considered a radiosensitive tumor. Radiation therapy produces initial fibrosis, loss of elasticity, fat necrosis, telangiectasia, lymphopenia, and obliterative arteritis. Tissue
Corley RD. The Efficacy of Mammography and Screening for Breast Cancer. JAMA. 1995;274(5):380-381. doi:10.1001/jama.1995.03530050028017