Mammography screening under 50: a limited perspective on a multifaceted issue.

Navarro and Kaplan's article on the cost-effectiveness of mammography screening for women under 50 offers a limited perspective on a complex and rapidly evolving issue. They suggest that eliminating mammography benefits for younger women will result in the delivery of other important women's health services, but they provide no data on the cost-effectiveness of these programs compared to mammography. Four other areas of omission significantly limit this article's scope and potential impact. Navarro and Kaplan do not discuss: 1) increasing breast cancer incidence in women under 50, particularly in African-American women; 2) the importance of breast cancer risk in relation to mammography screening; 3) the relevance of meta-analyses of randomized clinical trials done by other investigators; and 4) the heterogeneity of mammography screening recommendations in clinical practice.

Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder. Part I. Effects of demand characteristics and expectations.

Daily symptom ratings were evaluated in 31 women who met DSM III-R criteria for a diagnosis of Late Luteal Phase Dysphoric Disorder (LLPDD), and 34 women who reported no premenstrual symptomatology. Women in both groups were randomly assigned to be aware or unaware of the menstrual cycle focus of the study. Results revealed a consistent pattern of cyclic effects, with higher ratings in the mid-luteal, premenstrual and menstrual phases for many symptoms. Ratings of women reporting severe symptoms were not affected by knowing the purpose of the study and were higher than ratings in the asymptomatic group for many symptoms relevant to the LLPDD diagnosis. Awareness of the study focus did increase cyclicity in the ratings of asymptomatic women aware of the study focus compared with those who were unaware, but these differences were small and most were not significant. The implications of these findings for research and clinical diagnosis of PMS/LLPDD are discussed.

Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder. Part II. What makes a "real" difference?

Five degree of change criteria used in previous research to confirm premenstrual syndrome/late luteal phase dysphoric disorder (PMS/LLPDD) based on daily ratings were examined to determine how well each differentiated between women claiming to experience severe symptoms and women with normal menstrual experience. Frequency and nature of stressful events and subjective perceptions of impairment were also examined. Ratings were evaluated in 31 women who met DSM III-R criteria for a provisional diagnosis of LLPDD, and 34 women who reported no premenstrual symptomatology. Ratings for a sample of women taking oral contraceptives and a sample of men were also included for comparison purposes. Results indicated no differences between the groups in the frequency of stressful events. However, the PMS/LLPDD group rated their problems as more disturbing and evidenced a cyclical pattern in the occurrence of negative interpersonal interactions at work that was suggestive of some impaired functioning. None of the five change criteria differentiated the PMS/LLPDD group from the normally cycling No PMS group, and only one differentiated this group from the oral contraceptive No PMS group. This was true whether a liberal or conservative standard of confirmation was applied. The implications of these findings for using daily ratings to confirm PMS/LLPDD are discussed.

Daily moods and symptoms: effects of awareness of study focus, gender, menstrual-cycle phase, and day of the week.

Evaluated changes in daily ratings of moods and symptoms in 30 normally cycling women and 23 men. Women were randomly assigned to two groups for manipulating awareness of the study focus (aware vs. unaware). Principal-components analysis revealed six factors (Dysphoric Moods, Well-being, Physical Symptoms, Personal Space, Food Cravings, Depression) that accounted for 70% of the variance in daily ratings. Repeated-measures analyses revealed cyclic variation on each factor and no significant differences between aware and unaware women during premenstrual or menstrual phases on any measure. Unaware women reported less well-being than men during the premenstrual phase but did not differ on any other measure. Aware women did not differ from men in premenstrual or menstrual ratings on any measure. The way these findings relate to retrospective symptom reports, menstrual attitudes, and changes in moods and symptoms across the week was examined.