In October 2002, Dr. Thomas Kolb and colleagues published "Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: An analysis of 27,825 patient evaluations" in Radiology. In an editorial opinion, Dr. Daniel Kopans expressed reservations about the outcome of this study. The study authors now respond.
We regret Dr. Kopans' surprise and concern regarding our study, and hasten to assure him that a careful rereading of the article should allay his fears (Radiology, October 2002, Vol. 225:1, pp. 165-175).
First, he would discover that we agree with his statement that we present no evidence that ultrasound screening defers or prevents death, and have so stated in the paper. He would find that we already wrote that only a randomized controlled trial could possibly do so.
Given the expense of such a trial, we posit that it was necessary to show that ultrasound screening can detect additional cancers at all before such an endeavor should be launched -- and we are proud to have done so. We only hope that the practice might be proven to be efficacious, as mammography may be, but we realize that it may not be so.
Kopans would also discover that we never claimed to present the accuracy of ultrasound as a screen performed without mammography. Our figures apply only to the performance of ultrasound examinations that were conducted with the knowledge available from mammography and physical examination performed immediately prior to it.
When ultrasound detected a cancer that was not palpated, or seen during mammography, we deemed the lesion to have been found "by ultrasound alone;" we never performed ultrasound without mammography. Our terminology may have confused him, which we regret.
We do not share Dr. Kopans' opinion that the editors of Radiology are irresponsible and unfamiliar with principles of scientific validity. But we must sadly agree with him that some readers may misconstrue the implications of our paper -- and indeed, his letter supports this claim.
Still, it was necessary to present our data in order to consider performing the sort of trial that all of us agree is necessary. While my colleagues and I defend our demonstration that adding screening ultrasound to screening mammography detects cancers that are otherwise missed, we oppose any premature claims that the practice prolongs life, or has been proven to be a valuable standard of care.
By Dr. Thomas Kolb, Dr. Jacob Lichy, and Dr. Jeffrey NewhouseAuntMinnie.com contributing writers
July 11, 2003
To read the commentary by Dr. Daniel Kopans, click here.
Dr. Kolb is in private practice in New York City.
Dr. Lichy is in private practice in New York City.
Dr. Newhouse is at Columbia-Presbyterian Medical Center in New York City.
Related Reading
Breast cancer in younger women calls for flexibility in imaging, May 2, 2003
Ultrasonography improves cancer screening of dense breasts, September 20, 2002
Mammographers question newspaper’s ‘crusade’ against breast imaging, June 28, 2002
The opinions expressed in guest editorials are those of the author, and do not necessarily reflect the views of AuntMinnie.com.
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