In Reply Dr Chen’s main concern seems to be that our study does not have sufficient follow-up time. We used the longest follow-up times available from clinical trials and observational registries to estimate the relative contributions of screening and treatment on the reduction in US breast cancer mortality up to 2012. Chen was specifically concerned that the effect of the transition to digital mammography was not fully realized by 2012. To model the relative contributions of digital mammography on breast cancer mortality for several decades would require making assumptions about changes in clinical practice well beyond 2020. Screening with tomosynthesis and treatment with immunotherapy are a few examples of promising advances on the horizon in breast oncology that could affect the relative contributions of screening and treatment on breast cancer mortality over the next few decades. However, our analysis focused only on actual practice patterns.
Plevritis SK, Berry DA, Mandelblatt JS. Contributions of Screening and Treatment to Mortality From Breast Cancer—Reply. JAMA. 2018;319(22):2336. doi:10.1001/jama.2018.4261
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