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June 15, 1994

Mammographic Screening-Reply

JAMA. 1994;271(23):1828. doi:10.1001/jama.1994.03510470031023

In Reply.  —Dr Gambrell raises some interesting issues but appears to miss the fundamental conclusions of meta-analyses of screening mammograms: there is no evidence that mammographic screening reduces deaths from breast cancer in women younger than 50 years, and there is clear evidence that it increases the social, psychological, and economic costs of care.1 The fact that four of 15 of the cancers diagnosed in his practice were in patients younger than 50 years does not mean that this is a risk-free, cost-effective, or lifesaving procedure for this age group. Under no circumstances can individual clinical experience provide a scientifically valid assessment of screening practices in large populations. No amount of wishful thinking can supplant randomized controlled studies, which remain the gold standard.Indeed, Gambrell does not indicate whether the cases he diagnosed were found by screening mammograms, nor does he tell us whether this diagnosis saved their lives.

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