A letter from today's Wall Street Journal:

In response to your Nov. 19 editorial "A Breast Cancer Preview": Here is what has substantially changed in the clinical evidence regarding breast-cancer screening since 2002: The British randomized Age Trial limited to younger women under 50 and beginning at age 40 found a relative risk reduction of 17% and absolute risk reduction of 0.4/1000, but the results were not statistically significant (Lancet, 2006). Perhaps radiologists do not best know the medical literature, since the Lancet study has been cited six times in PubMed and 67 times in Google Scholar, but never by a radiology journal.

Furthermore, according to the 2006 Cochrane Review, about 10 women receive harmful overtreatment including mastectomies for pseudodisease found by "false true-positive" exams (not the false-positive evaluations) for every life saved. Finally, the relevant statistic with screening is not the lifetime development risk but the 5/1000 (0.5%) screen-free death risk from breast cancer for 40-year-old women over 15 years (Keen, 2009).

What is now clear is that the American College of Radiology knows that $3.3 billion is spent annually on mammography (The Wall Street Journal, Nov. 17). There is an obvious conflict of interest with screening mammography for radiologists and other doctors, including oncologists, which is a good reason for the USPSTF to be made up of independent experts using evidence-based methods clearly described in the Annals. I encourage my radiologist colleagues to read the study before condemning it, and to support informed decision-making regarding screening.

John D. Keen, M.D., M.B.A.
Brookfield, Ill.