The Efficacy of Mammography and Screening for Breast Cancer-Reply

In Reply.  —The purpose of our article was to determine which tests and procedures were appropriate for the detection and treatment of early breast cancer. We defined appropriateness by the effect of treatment on outcomes such as survival and quality of life. We did a cost-effectiveness analysis to permit decisions to be made concerning which procedures should be provided if resources become increasingly limited. Although screening mammography for women younger than 50 years can detect tumors at an earlier stage, there is no evidence from available clinical trials that this translates into improved survival. We cannot afford to perform procedures for which there is no benefit. The money saved by not providing routine screening to women younger than 50 years could be used for screening older women, screening high-risk younger women, and providing breast-conserving surgery for those in whom it is appropriate.We considered only the four options of screening,