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November 13, 1996

Screening Mammography and Risk of Breast Cancer

Author Affiliations

Beth Israel Hospital Boston, Mass

JAMA. 1996;276(18):1470. doi:10.1001/jama.1996.03540180026019

To the Editor.  —Dr Kerlikowske and colleagues1 state in their introduction that "approximately 11% of screening mammographic examinations performed in the United States are interpreted as abnormal, requiring the requesting physician to assess the likelihood that the mammographic finding represents breast cancer." These authors conclude by encouraging "radiologists to use the Breast Imaging Reporting and Data System [BIRADS] assessment categories when reporting screening mammography results, so that primary care physicians can interpret such results and use LRs [likelihood ratios] to estimate a woman's likelihood of breast cancer after screening mammography."I do not agree with the assumption of this article that primary care physicians need to personally assess the likelihood of breast carcinoma after the detection of abnormalities at screening mammography, most of which are nonpalpable. In the great majority of instances, the decision to obtain additional imaging studies and/or perform biopsy is a mammographic rather than clinical decision. In those few