An artful photograph
I was delighted with the Winter issue of Dartmouth Medicine, and not just because it contained an article that I wrote ["The Dufek File"]. I thought the whole issue was outstandingly good—starting with the "Editor's Note" and ending with the striking photograph in the "Art in Medicine" section. That photograph reminded me of Dartmouth's own Pilobolus dance company, which so effectively combines dance with athleticism.

In any case, it's a remarkable photograph. Thank you for making all alumni proud of Dartmouth Medical School.

Timothy Takaro, M.D., '42
Asheville, N.C.

Screenwriter
I appreciated the viewpoints expressed in "Are We Hunting Too Hard?" by Jennifer Durgin. [This Summer 2005 feature focused on the work of several DMS researchers who advise patients to make careful choices regarding cancer screening to avoid the "overdiagnosis" of "pseudodisease"—microscopic evidence of cancers that may never progress to causing symptoms but that result in a cascade of additional tests and sometimes unnecessary treatments, both of which can cause harm.]

I have personally been caught in the overtreatment cycle following a 2001 mammogram that showed microcalcifications. After two excisional biopsies, several second opinions, and much agonizing, I have decided to pursue watchful waiting. Along the way, however, I have been treated with criticism and disdain by doctors who refused to help me pursue watchful waiting. After all, it's my quality of life that I want to preserve. I think doctors should take that into account if they really want to serve their patients.

So from a patient point of view, I totally agree with the article. I can't say how much psychological harm I've endured. I feel guilty for not following my doctor's advice to have a mastectomy and angry that I'm being pushed to treat something that is very slow-growing and may never become invasive. Yet I don't want to leave my kids without a mother. So, yes, I agree with the doctors in the article who were quoted as saying that sometimes screening can do more harm than good.

Now I know how limited mammography is in detecting breast cancer. I think more research needs to go into being able to predict which cells are likely to become invasive cancer and which aren't, so women whose microcalcifications will never progress aren't treated unnecessarily. Hopefully, microarray technology will help with identifying gene markers and be available to clinicians soon. I hope I can wait it out until then! Also, more research needs to go into better screening methods, since mammography is not the total answer. Maybe something totally different needs to be looked into, such as a blood test for certain proteins or enzymes.

Anyway, thank you again for your good article.

Donna Carollo
Glenwood, Md.

Readers who missed the article referred to in this letter can find it here. In addition, those interested in the subject of breast imaging may want to read about a DMS faculty member who is researching a new modality.

Self-care convert
As a general practitioner in London, I read your Summer 2005 article on Dr. Martha Regan-Smith's self-care project with excitement, since I am taking steps to establish a think tank here in London exclusively dedicated to self care. I am convinced that it has an immensely important future. I appreciate learning of the people in Australia with whom she studied, and I plan to follow her work, too. Thank you for writing about it.

Dr. Fred Hansen
London, England

The shadow knows
I just finished reading "'Me and my shadow' is mantra for a new medical student elective" in the Summer 2005 issue of Dartmouth Medicine.

I would like to contact Ellen Ceppetelli, the nurse mentioned in the article, to ask her about her experiences in setting up the nurse shadowing program for medical students; such programs are much needed for all medical schools. Can you send me her contact information? Thanks very much for your help.

Sandy Summers, M.S.N., M.P.H.
Baltimore, Md.

Although we have a policy of not giving