Abstract
In Reply.— Dr Scarpa's letter raises some interesting and pertinent points. Our group was a small one, and the study clearly requires further evaluation with larger numbers of patients. Two such trials, to my knowledge, are currently being conducted. Unfortunately, the serum alkaline phosphatase determination does not appear to be a useful method of patient selection for scanning. In only one of our three patients with early bone metastasis was the enzyme concentration elevated preoperatively. Poor correlation has been reported by others. 1,2 We specifically excluded from study women below the age of 30 years, and patients who were thought to have benign breast disease on the basis of clinical examination, mammography, and thermography. We believe that this reduces the group of potential bone scanning candidates significantly, and we recommend future patient selection along these lines. Unexplained musculoskeletal pain certainly raises the index of suspicion for metastatic cancer, and these
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