Saving lives

Mammogram: New federal guidelines urge women age 40 and up to be screened every year or two.

February 25, 2002

CONFLICTING SIGNALS from scientists about the usefulness of mammograms leave thinking women no choice but to rely on mother wit:

Should she or shouldn't she undergo the minor annoyance of the routine X-ray screening for breast cancer? The life she saves might be her own. There should be no equivocating when it comes to that basic message.

Yet it has taken far too long for a declaration to emerge from the politicized community of breast cancer advocacy groups and competing scientists, who continue to confuse the necessary polemics of medical inquiry with the pragmatic health advice women want and need.

For two years, scientists have argued whether mammograms lower the death rate. The infighting boiled over in October, when two Danish researchers challenged the validity of decades of cancer studies that led to the widespread use of mammography.

Doctors have been unsure what to tell women. Patients have asked whether the screening is a nuisance or a necessity.

Cancer groups are trying to write policy statements that reckon with the great unknown, the same risk faced by every woman -- and man -- diagnosed with cancer. There is no guarantee that detecting the cancer early will save your life.

But health officials estimate that every year 190,000 American women get breast cancer and 40,000 die from it. If early detection gave you a fighting chance to cheat death, wouldn't you take that chance?

Last week, federal health officials attempted to stamp out the doubt about mammography even as their effort raised new questions about who should be undergoing routine mammograms.

The Department of Health and Human Services issued new recommendations urging women age 40 and older to get screened every one or two years. These guidelines are based on a two-year study by the U.S. Preventive Services Task Force, a well-respected independent panel convened to develop health recommendations.

The task force reviewed new studies plus the Danish scientists' work -- and agreed that early research was flawed. But it was unwilling to overlook the data from seven separate trials done in the 1960s through the 1980s, involving some 400,000 women. The Danish scientists condemned five of the studies, and said the remaining two did not prove mammography reduces deaths by breast cancer.

Task force representatives last week insisted that problems with the original research do not overshadow evidence that early detection of breast cancer can buy time for some patients -- measured in prolonged years of life.

Mammograms today are finding cancer when it is small and in early stages, when the options for treatment are greatest, says Dr. Neil Friedman, director of the Breast Center at Mercy Hospital in Baltimore. He estimates that 60 percent of his patients learn of their cancers through routine mammograms.

New federal guidelines will not, and should not, shut down healthy debate about the effectiveness and accuracy of mammography and other emerging technologies for finding cancer. Instead, they should spur the advocacy and medical organizations to firm up their positions and provide what women most need in the face of a killer like cancer: straight talk, truth and information.

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