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January 10, 1996

Cost-effectiveness of Mammography Screening

Author Affiliations

Erasmus University Rotterdam, the Netherlands

JAMA. 1996;275(2):111-112. doi:10.1001/jama.1996.03530260025022

To the Editor.  —The article by Drs Lindfors and Rosenquist1 does not meet the standard that has been set by earlier models.2-4 Five deficiencies of their analysis follow.

  1. Two strategies offer additional screenings (under age 50 years) compared with other strategies, but surprisingly these extensions are predicted to gain less years of life. This applies to the sixth strategy compared with the fourth, and the seventh compared with the sixth, as listed in Table 6. This alarming outcome is not mentioned, let alone explained by the authors.

  2. Assumptions on effects and costs of screening are taken from various sources without bothering about their consistency. A characteristic example is the assumed 4% breast cancer mortality reduction for biennial screening compared with 23% for annual screening. Normally one would expect that doubling of the screening frequency less than doubles the mortality reduction: of the detected cases in two successive annual