Dr. Mahoney replies
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* Leo J. Mahoney

We agree with Dr. Moffat that our 45-year-old patient in whom we cannot palpate any lump should undergo mammography as part of her complete assessment.1 It is included in the program of breast screening that we recommended for her along with an annual clinical examination and instruction in breast self-examination.2 Undoubtedly, the message would have been clearer if we had called it a diagnostic mammogram which, if normal, could serve as the first mammogram of a screening program.

I am sure that all women would appreciate an additional clinical examination by their physician at the 6-month interval as Dr. Moffat suggests.

## References

1.  Clinical practice guidelines for the care and treatment of breast cancer. CMAJ 1998;158(Suppl 3):3, 4.
    
    

2.  National Institutes of Health Consensus Conference on Breast Cancer Screening for Women Ages 40–49. Proceedings. Bethesda, Maryland, USA. January 21–23, 1997 [review]. J Natl Cancer Inst Monogr 1997;22:vii-xviii, 1–56.