In Reply: We agree with Dr Magee that it is important to consider both survival and cost consequences of imaging tests. This is particularly true of breast cancer screening, which involves large numbers of women and repeated annual testing. The cancers seen only with screening ultrasound are nearly all invasive and node-negative at detection. Left undetected, these invasive cancers may spread to axillary nodes prior to diagnosis, worsening the prognosis. Across 7 RCTs of mammography, the decrease in mortality observed parallels reduction in node-positive cancers.1
Berg WA, Mendelson EB. Ultrasound and Mammography for Breast Cancer Screening. JAMA. 2008;300(13):1514–1515. doi:10.1001/jama.300.13.1515-a
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