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November 14, 1977

The Breast Cancer Controversy

JAMA. 1977;238(20):2141-2142. doi:10.1001/jama.1977.03280210033003

To the Editor.—  I am left rather confused by the article by Black et al concerning the apparent lack of impact of mammography on the stage of breast cancers coming to surgery (237:970, 1977). No indication is given as to what role mammography played in these cases other than the statements that "[since November 1974] the vast majority of breast lesions treated by the general surgeons have had preoperative mammography," whereas one surgeon (the specialist) had used it for ten years.Obviously, mammography cannot have an impact if it does not materially affect the selection of those who are to come to surgery. Usually, patients coming to surgeons have already been preselected, by the fact of referral, for the presence of clinical signs and symptoms, thus eliminating the opportunity for mammography to provide a precocious diagnosis. Even for those patients coming directly to the general surgeons or the specialist, there