Mammograms

Statistics of breast cancer leap from billboards and public service ads everywhere: One out of nine women will develop the deadly disease if she lives to be 85.Thirty years ago, it was one woman out of 16.Although these numbers are partially influenced by earlier cancer detection and longer life spans, no one knows why the incidence of breast cancer is growing. And breast cancer activists point out that mortality rates remain virtually the same as they were in the 1950s.It also appears the disease is increasing in younger women.

As Mother's Day approaches, health organizations are once again gearing up to send mothers -- and daughters -- a powerful message about breast cancerThe message: Catch it early. Get a mammogram.But this week, many younger women will be greeting this appeal with profound confusion and annoyance. News trickling out of a massive study of Canadian women has suggested that women in their 40s who get annual mammograms do nothing to lower their chances of dying of breast cancer."I've had calls today from patients who are reasonably hysterical," said Dr. Alex Munitz, chairman of radiology at the Greater Baltimore Medical Center and a vocal critic of the study.

A new study in a British medical journal has stirred a passionate debate among doctors in Europe and the United States by asserting that mammograms do not prevent women from dying of breast cancer or help them avoid mastectomies. The question is dividing experts and women's health advocates, many of whom acknowledge that they do not know what to think about the new report. For more than two decades, annual mammograms have been part of life for millions of women, with the American Cancer Society and the National Cancer Institute urging women to have them.

Two-time breast cancer survivor Lillie Shockney knows mammograms save lives. Her patients at Johns Hopkins Hospital heed her advice when she implores that screening can detect the disease early enough to fight it. And women all over the world e-mail her anxious questions about how to protect themselves from cancer at all costs. When should they begin having breast X-rays and how often? Are mammograms sufficient or should they demand sophisticated MRI scans? What about their daughters - how soon should they have mammograms?

As debate flares anew over the ability of routine mammograms to prevent breast cancer deaths, Dr. Naji Khouri knows what he can and cannot claim. The Johns Hopkins radiologist can't claim that he can detect every tumor, or that every tumor he detects can be cured. But he does contend -- vehemently -- that some tumors, perhaps the majority, can be cured if they are caught at an early stage. And for that to happen, he says, a woman needs routine mammograms, no matter what the critics say. "The majority of breast cancers are going to be slow-growing, and that allows us to cure them," says Khouri, an associate professor of radiology at the Johns Hopkins School of Medicine.

T he recommendation by the U.S. Preventive Services Task Force that mammograms not be given routinely to women under 50 and that the teaching of self-exams be de-emphasized has sparked a spirited debate among doctors, researchers, advocates and ordinary women. That's a good thing. The questions of when such screenings are most effective and what benefits and risks they provide are too seldom considered in a medical culture that tends to assume more tests are always better. There are thousands of examples of women whose potentially deadly cancers were caught early because of mammograms, and many others in which women suffered unnecessary consequences ranging from anxiety to needless treatment because the tests raised false alarms.

WASHINGTON - A new analysis of mammography, the latest in a series to address the question of whether breast cancer screening saves lives, has found that the tests reduce the risk of dying from the disease by one-fifth. The study, being released today by a team of Swedish researchers, concluded that the benefits of breast cancer screening were greatest for women older than 55. Among younger women, the benefits were not statistically significant, the study found. The research is likely to do little to settle the debate among scientists and statisticians over the value of mammograms.

In the simmering debate over the value of regular mammograms, critics argue that they lead to unnecessary biopsies, treatments and anguish. Barbara Olsen, 46, endured a cancer scare last year when a suspicious mammogram led to a biopsy that revealed nothing but a benign lump. Another woman, a research scientist in Washington, has endured three "false positives" that triggered biopsies and agonizing waits for results. And Linda Osborne, 53, had surgery and radiation for a type of breast cancer that might never spread if left alone.

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.