New Philadelphia research endorses mammograms for women in 40s

March 14, 1994|By Knight-Ridder News Service

PHILADELPHIA -- A new 20-year study by doctors at Thomas Jefferson University Hospital gives strong new evidence of the importance of mammograms in detecting breast cancer and renewed arguments for screening women in their 40s.

Nearly a third of 3,752 women given biopsies as a result of suspicious mammogram findings were found to have cancer, according to the study, to be published tomorrow in the journal Cancer. All those women were without symptoms and had no lumps that were detectable to the touch.

In nearly 30 percent of the women with cancer, the disease was caught in an early form that had not spread beyond the breast and often could be treated without mastectomy or radiation, said the principal researcher, Dr. Gordon Schwartz, a professor of surgery and specialist in breast diseases.

"Without access to mammography, these women would be denied this earliest detection," said Dr. Schwartz.

He said the study may represent the largest group of patients in the country ever to undergo biopsies based on mammogram results.

Findings of the study were not broken down by age. But Dr. Schwartz and co-author Dr. Stephen A. Feig, director of the Jefferson breast imaging center, said their work points to a continuing need for routine mammograms for women in their 40s. About 25 percent of the women in the study were under 50, they said.

In December, the National Cancer Institute abandoned its long-standing recommendation for routine mammograms for symptomless women in their 40s, while continuing to call for the tests for women 50 and older.

The institute maintains there is a lack of proof of a need for mammograms for women in their 40s, despite convincing evidence of their value for women 50 and beyond. Critics have countered that studies cited by the NCI included few non-whites. African-American women die of breast cancer at a disproportionate rate.

But Dr. Schwartz and Dr. Feig, like medical organizations including the American Cancer Society, continue to urge tests for symptomless women in their 40s.

"Failure to screen women under 50 would be a great leap backward in the early detection of breast cancer," said Dr. Schwartz, who said he had sent a copy of the study to a group in Washington that is lobbying on the proposed national health care plan.

Advocates of early cancer screening are concerned the Clinton administration health-care package will exclude mammograms for women in their 40s.

Dr. Schwartz said another key point of the Jefferson study is that careful study of mammograms by skillful radiologists and surgeons can mean fewer biopsies.

And the earlier cancer is caught, the less likely the need for such expensive treatments as mastectomy and radiation, said Drs. Schwartz and Feig.

"Our experience indicates that high quality mammography is able to detect substantial numbers of early breast cancers among women aged 40 to 49 years," said Dr. Feig. "A significant proportion of patients with cancer might have been overlooked if their mammograms had not been performed because they were still under 50 years of age."

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