Abstract
In Reply.—Dr Merenstein has raised important issues about the cost-effectiveness of breast cancer screening in the elderly.Screening mammography has decreased the mortality from breast cancer,1-3 and there is complete agreement on its benefit for women older than 50 years.2 A meta-analysis of the randomized studies has demonstrated a reduced breast cancer mortality with screening2 despite concerns about technical merits and quality control in some of the studies.1 Dealing with subgroups in these randomized studies, however, poses considerable difficulties.1 This is evident in the controversy that has arisen over screening in the 40- to 49-year-old group.1-3 Similarly, the number of women older than 70 years in these studies is too few to make any conclusions about alteration in mortality. This, however, should not lead to the erroneous conclusion that screening is ineffective for the elderly. We must recognize that breast cancer increases in