Mammography Screening in Women Under Age 50 Years

Abstract

To the Editor.— We are in full agreement with the major conclusion reached by Eddy et al 1 that routine mammographic screening of asymptomatic women younger than age 50 years is unwarranted. We do, however, have serious objections to their seemingly uncritical acceptance of the widespread notion, expressed in their article and in the editorial by Bailar, 2 that annual clinical breast examination starting at age 40 years is justified in a screening situation. From 1974 to 1984 more than 50 000 women were screened regularly for breast cancer in the DOM Project, a large ongoing breast cancer screening project in Utrecht, the Netherlands, by means of clinical breast examination and mammography. The sensitivity and specificity of this diagnostic combination were 96% and 99%, respectively. If mammography alone had been used the sensitivity and specificity would have been 95% and 99%, respectively. Clinical examination alone, on the other hand, would