Why isn't every woman over 40 in a breast cancer detection program?

Mortality from breast cancer may be reduced by more than 10,000 deaths per year in this country if the recommendations for screening all asymptomatic women older than 40 years for breast cancer, issued in 1982 by the American Cancer Society and the American College of Radiology, are followed. Compliance with those recommendations six years later is poor, even in well-to-do, medically served populations, primarily because of poor compliance by physicians. Radiation risk is an often-cited concern, although it has been shown to be an insignificant factor in breast cancer screening. High cost, also cited as a concern, is less of a problem-the charges for mammography having declined steeply in the past few years. At the current price levels, it makes financial and humanitarian sense to provide screening rather than terminal care for metastatic breast cancer. The third concern cited by physicians, that of diagnostic accuracy, must be addressed by a careful and accurate statistical description of the results of each screening program. Sensitivity of more than 80% with positive predictive values of about a third can be achieved.