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The Efficacy of Mammography and Screening for Breast Cancer-Reply

Karla Kerlikowske, MD; Deborah Grady, MD; Susan M. Rubin, MPH; Virginia L. Ernster, PhD
JAMA. 1995;274(5):382-383. doi:10.1001/jama.1995.03530050028021.
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In Reply.  —Dr Hill argues that all of the randomized screening mammography trials that we pooled are flawed and should not be used to conclude that mammography is not beneficial for women aged 40 to 49 years. However, results from these same trials are used to support screening for women aged 50 to 69 years. Despite some cross-over and variation in type of intervention, all trials show a significant reduction in breast cancer mortality among screened women aged 50 to 74 years beginning at 7 to 9 years of follow-up. In contrast, among women aged 40 to 49 years, no pattern emerges among trials after 7 to 9 years of follow-up.Hill suggests that what is needed is an analysis of the raw data or a large randomized trial in women aged 40 to 49 years. While pooling raw data might answer some ancillary questions, the overall summary estimate is


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