sed with late-stage cancer, women were more likely to be in the absence-of-screening group if they were aged 75 years or older, unmarried, or did not have a family history of breast cancer. In addition, women who had less education or lower income were more likely to have been in the absence-of-screening group.

"To reduce late-stage cancers, priority should be given to promoting screening among those women without a mammogram within 2 years and improving breast cancer detection at the time of screening," the authors write. "Top priority, however, should be given to reaching unscreened women, especially those who are likely to be older, to have a low annual income, and to have less education, even in organized health plans."

In the editorial, Michael Baum, M.D., of University College London, takes issue with this interpretation of the data and discusses three common sources of possible bias that apply to breast cancer screening. He notes that the effect of increasing the number of women who receive mammograms would be limited because the incidence of interval cancers--cancers diagnosed after a negative screening mammogram--would not change. "[E]fforts directed at improving the socioeconomic status of women in lower strata might indirectly have a greater effect on reducing breast cancer mortality than efforts directed at attaining universal mammography," he writes.

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Contact: Sarah L. Zielinski
jncimedia@oupjournals.org
301-841-1287
Journal of the National Cancer Institute
19-Oct-2004

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