In Reply

Abstract

In Reply—I do not believe there is a great difference of opinion between the conclusions of my article and Dr. Carlson's concerns. I clearly outlined the lack of studies on the efficiency of cancer screening in the elderly, and certainly more research in this area is needed. Dr. Carlson's concern over poor patient acceptance of regular sigmoidoscopy and Pap smears may be as much because of poor physician understanding of the rationale for these tests as it is because of poor patient acceptance.1 The “recent publication” mentioned by Dr. Carlson is the excellent article by Dr. Eddy on “Screening for Breast Cancer” 2; the conclusion of which begins with the following statement: “There is excellent evidence that breast cancer screening with a combination of mammography and breast physical examination reduces mortality from breast cancer for woman over 50 years of age.” This is a conclusion with which I agree, even accepting Dr. Carlson's concerns over the large cost that screening mammographies will generate. I have searched my article repeatedly to see where I am generating the theory that “more is better.” I do feel that more research is better before coming to firm conclusions on the role of cancer screening in the elderly. I will leave it to the reader to decide how much evidence is needed before recommending screening cancer tests to elderly patients; however, I do think physicians as a group need to be better educated on the high incidence of cancer in the elderly and at least discuss the option of cancer screening with the patients. Ultimately, I feel the patient will make the decision that is best for himself or herself.