I read "Mammography Saves Lives-Or Does It?" (Viewpoint, January) with great interest. Providing clear information to women on the early detection of breast cancer is indeed a challenge for nurses. I would like to add the following points.

There are three primary tools used for the early detection of breast cancer: breast self-examination, clinical breast examination (performed by a clinician), and mammography. Each tool has its own strengths and weaknesses; that's why they are often combined-one is not a substitute for the other.

Conflicting research findings have resulted in the issuance of several guidelines regarding the early detection of breast cancer. The confusion stems from differences in populations considered (for instance, women of diverse ages), thresholds for measuring the effectiveness of tests (sensitivity and specificity), costs, risks associated with the screening tests, and the missions of the recommending agencies. The many recommendations, which I have recently summarized, 1 are appropriate for use in women who are at average risk for developing breast cancer. Those at higher risk should receive recommendations based on the level of risk.

Every woman's risk of breast cancer should be assessed and explained to her in understandable terms. The known benefits and risks associated with each of the three early-detection tools should be presented. She can then make an informed decision based on her situation and level of risk.

Nurses have an enormous responsibility to women: to interpret research and discuss the early detection of breast cancer in a way that's honest, understandable, and not frightening.

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