The article by Welch and Frankel ([1]), and the commentary by Wilt and Partin ([2]) address an issue that belongs in the lay press - not a medical journal.

No expert has argued in scientific support of mammography screening that, because someone claims their life was saved by screening, this, somehow, supports screening. The serious support for screening comes from the data from randomized, controlled trials (RCT) and large observational studies that clearly show that deaths from breast cancer are reduced by early detection.

The authors should be well aware, that it is not possible to determine, specifically, whose life has been saved by screening. This is the reason for the need to perform RCT. This paper is simply a distraction from the enormous amount of scientific evidence that supports screening.

Dr. Wilt, who wrote a supporting commentary, is on the United States Preventive Services Task Force (USPSTF) that dropped support for screening women ages 40-49, and told women ages 50 and over that they could be screened every two years. The USPSTF issued their guidelines knowing full well that for women ages 50 and over, their own modeling showed that at least 20 percent of lives that could be saved by screening annually, would be lost by screening every two years.

For women ages 40-49, the results of not screening are even more sobering. Using the models used by the USPSTF, Hendrick and Helvie calculated that among women who are now age 30-39 (entering their forties over the next 10 years), following the USPSTF guidelines would mean that as many as 100,000 lives would be lost from breast cancer that could have been saved by annual screening beginning at the age of 40 ([3]).

Welch and Wilt ignore the scientific fact that tens of thousands of lives have been saved since screening began in the U.S. Prior to 1990, the death rate from breast cancer had been unchanged since 1940. Screening began in the U.S. around 1985, and the death rate from breast cancer has declined by more than 30% since 1990.

The fact that an individual can never be certain their own life was saved, is no reason to ignore the scientific evidence that thousands of lives are being saved by annual mammography beginning at the age of 40.