Anthony B. Miller, MB, FRCP

It is perhaps not surprising that the increased incidence of a disease that has a major impact on mortality in young women (even though the absolute risk of death from breast cancer in this age group is low) should create so much interest. Yet, despite decades of research, it is by no means clear that everyone would agree with King and Schottenfeld that the appropriate approach to breast cancer prevention is one that "focuses on the physiologic effects of the sex steroid hormones and their potential interactions with family history." However, this tantalizing statement appearing at the end of the abstract of their article fortunately is elaborated upon at the end of the article itself. This elaboration refers specifically to physical activity, energy consumption, obesity, pregnancy history and exogenous estrogens and their potential interactions with family history, with which many will agree.

Esserman and Kerlikowske have done an excellent job in reviewing the factual information on screening mammography for women age 40 to 49 years. Their review builds on some previously published work by Kerlikowske and colleagues, particularly their meta-analysis [1]. This meta-analysis was important, in that it addressed the issue of timing in relation to mammography screening in women 40 to 49 years old, as compared with those 50 to 69 years of age. The combined data of eight randomized trials clearly demonstrated that there was absolutely no benefit of mammography for women age 40 to 49 at 7 to 9 years after the initiation of screening. In contrast, for women age 50 to 69, there was a substantial and statistically significant reduction in breast cancer mortality.