So difficult to make our own decisions

February 04, 1997|By MONA CHAREN

WASHINGTON -- An expert panel was asked by the National Institutes of Health to provide a recommendation: Should women in their 40s get routine mammograms?

When the panel held a press conference to release its recommendation, the doctors and other experts said the science offers no clear guidance. While there is no controversy that mammograms every year or two for women in their 50s are beneficial (decreasing by 30 percent the likelihood of dying of breast cancer), the data for mammograms on younger women are inconclusive.

Accordingly, concluded the panel, women in their 40s, in consultation with their doctors, will have to make their own decisions.

The recommendation, which everyone assumed would go the other way, was greeted with outrage and fury. Members of the panel were called frauds and worse. They were accused of condemning thousands of American women to death. The report and its ''surprising'' conclusions led the evening news.

What goes on here? Well, first, there is the matter of money. Mammography is big business in the U.S. Who has not been moved by the beautiful television commercials reciting that one in 11 of our ''mothers, wives, daughters, sisters, grandmothers'' will get breast cancer? The ads are disturbing but reassuring, too, conveying as they do the message that early detection is the key to survival. Medical centers and radiologists would like us to believe that.

But the truth about mammograms is more complicated. According to the NIH panel, mammograms miss 25 percent of malignant tumors in women in their 40s, compared with 10 percent in older women. The younger the woman, the denser the breast. This makes it more difficult to see tumors on X-rays.

Moreover, if mammograms are done routinely on women in their 40s, the tests will produce 30 percent to 40 percent false-positive results -- meaning needless anxiety and possible surgery and other medical interventions that are not without risk.

Over-terrified and oversold

We have all been over-terrified about breast cancer (heart disease kills more women) and oversold on mammograms. Alas, not every tumor starts small and can be rendered harmless by early detection. Some just explode seemingly overnight. Some are deadly no matter how early they are found. Others will not kill even if left untreated for years. I even heard a famous breast-cancer specialist, Susan Love, express doubts about monthly self-examination. To be sure, it does no harm, she said. But women who don't do it should not feel guilty.

The New York Times explained the risk/benefit balance by quoting Donald Berry, a Duke University statistician and member of the panel: At best, ''98.5 percent of women in their 40s will get no benefit'' from mammograms. ''The other 1 1/2 percent have their lives extended by 200 days.''

Of course, any individual woman who believes that she is at higher than average risk for breast cancer should go ahead and be X-rayed. The question the panel was addressing was whether it was, on balance, beneficial for everyone to be tested.

Why is it so difficult to be told to make our own decisions? When we're pregnant, we know that having amniocentesis carries the risk of causing a miscarriage. For women under the age of 35, the risk of conceiving a baby with Down's syndrome and other genetic problems is lower than the risk of losing the pregnancy because of the amnio. Accordingly, most women under 35 (except those with a family history of certain problems) forgo the test. Most women over 35 (except those who would not abort under any circumstances or who do not feel the need to prepare for the birth of a disabled child) have the test.

Women make these decisions all the time, weighing benefit against risk. Why should it be different for mammograms?

Breast cancer is perhaps at its most ghastly when it strikes xTC young women, particularly mothers. But the bleak truth that the panel confronted and its critics won't is that mammograms do not provide a sure-fire answer.

Mona Charen is a syndicated columnist.

Pub Date: 2/04/97

Baltimore Sun Articles
|
|
|
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.