We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Screening Mammograms Should Not Be Underestimated

Mary E. Costanza, MD
Arch Intern Med. 2012;172(5):446. doi:10.1001/archinternmed.2011.1882.
Text Size: A A A
Published online


I find the article “Likelihood That a Woman With a Screen-Detected Breast Cancer Has Had Her ‘Life Saved’ by that Screening,” by Welch and Frankel,1 disturbing for several reasons. First, while looking at 20-year survival data has its merits, one should not forget the advances made in annual screening in the last 2 decades and with it the increase in detection of smaller cancers in earlier stages. Surveillance Epidemiology and End Results (SEER) and service data both highlight the downward shift in stage at diagnosis, with 74% of cancers diagnosed at stage 0 or 1.24 Service data comparing biennial with annual mammograms show the median decrease in size from 15 mm to 11 mm and the decrease in positive axillary lymph nodes from 24% to 14%.5 From various clinical trials, the survival curves for the smallest cancers (ie, <1 cm and negative nodes) appear to level off at 95%, suggesting that a cure may have been achieved. At present, consistent discovery of small potentially curable breast cancers is only possible with mammography or other radiologic screens. The push for regular annual screening is driven by the hope of increasing actual cure rates.



Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Breast Cancer

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How?