Newspaper article St Louis Post-Dispatch (MO)

Conflict Deepens in Mammogram Debate

Newspaper article St Louis Post-Dispatch (MO)

Conflict Deepens in Mammogram Debate

Article excerpt

The long, bitter argument over the value of breast cancer screening for women under 50 took a surprising turn Thursday, leaving younger women with conflicting guidance on the value of mammograms.

A panel of experts appointed by the National Cancer Institute reported that there was still too little evidence to justify a government recommendation that all women in their 40s get annual mammograms to help detect cancers. That decision should be left up to each woman and her doctor, the panel said.

But the director of the cancer institute immediately challenged its conclusions. So did the American Cancer Society. "The data supporting the benefit of screening women in their 40s is stronger than it had been," said the institute's director, Dr. Richard K lausner. "Women need to know that." He cited five recent studies in Sweden indicating that women who started getting mammograms in their 40s suffered 20-30 percent fewer cancer deaths than women who were not screened. Earlier studies were less clear. There is general agreement that mammograms after the age of 50 are beneficial and reduce the cancer death rate by about 35 percent. But the relative risks and benefits of screening for younger women have generated enormous controversy. Breast cancer is the leading cause of death among women in their 40s but is still relatively uncommon. A 40-year-old woman has a 2 percent chance of being diagnosed with breast cancer by the time she is 50, and a 3-in-1,000 chance of dying from the disease. The risks of breast X-rays include exposure to radiation, which itself can lead to cancer, as well as the possibility of a misleading false alarm, which can cause emotional distress, the loss of insurance or an unnecessary mastectomy. These risks are justified in the case of women over 50, said Dr. Leon Gordis, a professor of epidemiology at Johns Hopkins School of Medicine in Baltimore, who headed the panel. But younger women must balance them against the uncertain benefits of early detection of cancer, he said. The so-called "consensus development panel" was set up in hopes that it would clear up the confusion of conflicting advice. The eight women and five men - eight of them doctors - reviewed more than 130 scientific studies and spent three days listening to speakers on all sides of the issue, including breast cancer survivors, physicians, researchers and medical statisticians. But instead of reaching a consensus, the panel seems likely to increase the uncertainty and anxiety of younger women who are unsure what they should do to reduce the risk of dying of breast cancer. "That concerns me," said Klausner, a leading cancer researcher before he took over the federally run institute in 1993. "I am concerned that women are not being given all the evidence they need in this report. …

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