Affiliations of authors: Department of Medicine, University of Washington, Seattle (JGE); Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (DFR).
Correspondence to: Joann G. Elmore, MD, MPH, Department of Medicine, Division of General Internal Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359780, Seattle, WA 98104-2499 (e-mail: jelmore{at}u.washington.edu)
Our literature search, as outlined in the "Methods" section of our recent article (1), reviewed MEDLINE peer-reviewed publications up to mid-2002 that included three search terms: "mammography," "mass screening," and "biopsy". The references noted by Onysko et al. in their correspondence were not identified by our search because they were either published in 2003 (i.e., were not in the peer-reviewed literature at the time of our search) or did not use the specified key terms.
Screening practices in Canadian breast cancer screening mammography programs may differ from those in the United States in several ways. Indeed, the medical malpractice environment, fiscal incentives, health care structure, and breast cancer screening recommendations differ between the two countries. We strongly suspect that our findings reflect differences in screening performance mainly between U.S. screening mammography programs and screening results from other countries.
Our findings are consistent with another recently published article (2), in which screening mammography performance was compared between the United States and the United Kingdom. In that study, the recall rate and negative open-surgical biopsy rates were twice as high in United States settings as they were in the United Kingdom, whereas the cancer detection rates were similar in both countries.
We agree with Onysko et al. about the need for standardization of international comparisons of screening program performance. However, the data required for meaningful comparison of screening performance are, unfortunately, not always available in the existing published literature (for example, the type of diagnostic assessment performed or definitions used to calculate outcomes). The conceptual model and brief discussion of the potential reasons for variability among published studies of screening mammography [Table 3 in (1)] may be helpful in making comparisons of screening program performance in future studies.
REFERENCES
1 Elmore, JG, Nakano, CY, Koepsell TD, Desnick LM, D'Orsi JC, Ransohoff DF. International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst 2003;95:138493.
2 Smith-Bindman R, Chu PW, Miglioretti DL, Sickles EA, Blanks R, Ballard-Barbash R, et al. Comparison of screening mammography in the United States and the United Kingdom. JAMA 2003;290:212937.
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