REBUTTAL

OF ARTICLE
BY DR. LETTON
et al. Cancer 1977

JOHN C. BAILAR
111, MD, PHD

,.I he recent article by Letton et al.’ may result in serious
misunderstanding. T h e final sentence of the summary was,
“To increase survival rate by 24.1% against a theoretical
increased risk of 0.16% is definitely worthwhile.” T h e casual
reader may not understand that the estimated improvement
of 24.1 % applies only to the 32 women found to have breast
cancer, while the risk of 0.16% applies to all 5810 women
who were screened. Thus the figures are not comparable.
1,etton el al. do give some of the data for a n appropriate
comparison. They estimated that eight lives were saved by
the screening examination (24.1% of 32), and apparently a
little over half of that was attributable to mammography.
‘I‘hus one may estimate the benefit of mammography as
about 5 lives saved. O n the other hand, Letton et a / . stated
that “To calculate the numbers of cancers, theoretically,
that we would expect to be caused by this radiation during
the lifetime of the entire group of 5810 women would be
9.412,” (or 0.16% of 5810).
These fig-ures (approximately 5 lives saved and approxi-
mately 9 extra breast cancers caused) are rough statistical
summaries that still cannot be compared without further
analysis (see, ‘.g.,’).However, the authors’ own data do not
seem to support their conclusion that “screening this group
of women is definitely to their advantage.”
O n the contrary, mammography for asymptomatic
women under age 50 remains doubtful, at best (2).

REFERENCES

1. Letton, A. H., Wilson, J. P., and Mason, E. M . : T h e 2. Bailar, J. C., 111: Screening for early breast cancer:
value of breast screening in women less than fifty years of Pros and cons. Cancer 39:2783-2795, 1977.
age. Cancer 40: 1-3, 1977.

From the National Cancer Institute, National Institutes of

Health, Bethesda, Maryland.

0008-543X-78-0300-1211-0050 @American Cancer Society

REPLYTO REBUTTAL
LETTERBY DR. BAILAR
A. HAMBLIN
LETTON,MD

I appreciate the tenacity in Dr. Bailar. He keeps on
trying. Actually, our statistics are better this year than last
where we have found some more early cancers of the breast
in the less than 50 year old women. We, undoubtedly, would
have found more if the guidelines had permitted routine
screening in this group.
It is interesting to note that the statisticians now claim
that the followup of these 280,000 women in the various
centers is useless. I n spite of all this “harmful radiation” that
they have been given, the estimated number of cancers theo-
retically caused in these 280,000 women will not be large
enough to be statistically valid. I would think this statement
closed the question of radiation hazard in mammography. If
it will not be statistically valid in 280,000 women, it must be
very insignificant.

From the Breast Cancer Screening Project of The Atlanta

14edical Center at Georgia Baptist Hospital, Atlanta,
Georgia.
0008-543X-78-0300- 1211-0050 @ American Cancer Society
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