Consider the mammogram a new entry in the Important Things in Life Are Complicated File:
Last December, the National Cancer Institute pulled back its 1987 recommendation that all women in their 40s get routine mammograms. It stated there was no conclusive evidence to suggest the examinations significantly reduce breast cancer deaths in that age group.
In a recent Chicago fundraising event, officials of the American Cancer Society were speaking out against the National Cancer Institute, which is considered a major partner in the fight against breast cancer.
“We have put great effort into making mammography a household word and the practice of having a mammogram as automatic as wearing a seatbelt,” said Dr. Stephen F. Sener, president of the American Cancer Society’s Illinois Division. “We have made great progress. Now we’re concerned the National Cancer Institute is taking a big step backward.”
Sener said both National Cancer Institute and the American Cancer Society recently reviewed eight international studies of screening mammography. “We found that, for women in their 40s, mammograms reduced the risk of dying from breast cancer by about 10 percent, a decade after the studies were started. NCI decided this 10 percent difference between those having mammograms and those not having mammograms is not `statistically significant.’ We disagree.”
Well, sort of, said Dr. Harmon Eyre, another speaker at the Chicago event.
“We’re looking at the same data,” said Eyre, the American Cancer Society’s deputy exective vice president for medical affairs and research. “We’re not that far apart. NCI is saying mammograms work for women in their 40s if they have a high risk (family history). We are saying it works but doesn’t have to be high risk. We admit we don’t know if it reduces mortality, but we say do the mammography screening until we know better.”
An honorable view, explained Dr. Edward J. Sondik, deputy director of the institute’s Division of Cancer Prevention and Control.
“We feel women should be given the facts,” Sondik said from his office in Bethesda, Md., “then discuss the facts with their health practitioner and make a decision about mammograms. We think either decision is reasonable provided a woman is comfortable with it.”
Sondik said the institute retreated on its original mammogram recommendation for women in their 40s because “our recommendation is like a promissory note; we thought then such exams would deliver lower death rates, and so far they have not done so.”
One fact that might be overlooked, said Sondik, is that mammograms are invasive-“more powerful than a standard front chest X-ray”-and so are subsequent follow-up procedures on false-positive tests, including biopsies in some cases.
The particulars about mammograms and women in their 40s are subject to keen debate by institute, the society and other key medical groups, such as the Radiological Society of North America, American College of Physicians, Preventive Services Task Force, American Academy of Family Practice and more than 15 other organizations. At its December 1993 convention in Chicago, the Radiological Society showed initial data that regular mammography can cut the death rate in women ages 40 to 49 by as much as 26 percent.
In a move welcomed by all sides, key executives from National Cancer Institute and the American Cancer Society are talking this weekend in Washington, D.C., to prepare for a mammogram summit for all relevant organizations in Atlanta April 20 and 21. The purpose of the summit is to consolidate information for the public.
Sondik apologized for “it being complicated” but stresses that if the decision about regular mammograms is too easy to make for a woman in her 40s, she is not getting enough information.
“We always say to get a second opinion,” he said. “The same goes here. Find out what two differing but respected organizations have to say before you decide.”
“We are most concerned that the value of mammograms seems to be in dispute, and that as a result, even older women will not get them done,” Eyre said.
“That’s the downside here,” said Sondik. “We have to do all we can to counteract that.”
