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Government Backs Lifesaving Ability of Mammograms

Endorsement could end recent furor over merits of screening tool

THURSDAY, Feb. 21 , 2002 (HealthDayNews) -- If you're one of millions of women confused by the recent debate over the merits of mammography, the news is good: Secretary of Health and Human Services Tommy G. Thompson today announced the government's continued backing of regular screening mammograms as a lifesaving tool.

"The federal government makes a clear recommendation to women on mammography: If you are 40 or older, get screened for breast cancer with mammography every one to two years," Thompson said at a press conference in Washington, D.C.

Although acknowledging that more advanced methods of detecting breast tumors may become available in the future, he declared mammography "a strong and important tool in the early detection of breast cancer. The early detection of breast cancer can save lives."

This position was endorsed by Dr. Andrew von Eschenbach, director of the National Cancer Institute (NCI), who added, "Mammography remains an important part of our effort to save lives through early detection."

Thompson based his announcement on the newest recommendations made by the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically reviews all available data and makes recommendations on clinical preventive services such as mammography.

In 1989, and again in 1996, USPSTF recommended mammography for women over age 50. In the new report, the panel extended its recommendations to include regular mammograms for all women over age 40, while citing evidence that women between 50 and 69 will reap the greatest benefit and reduced death rates from breast cancer.

Today's statements may well end the recent uproar over the effectiveness of mammograms.

The controversy began last month when The New York Times published a report on study findings in the prestigious medical journal The Lancet that concluded mammograms don't save lives. The study, which appeared in the journal in October 2001, analyzed two already questionable breast cancer trials in a new way. The findings were largely dismissed by the medical community when they first appeared.

However, the study took on a new life when the Times published its story, followed by a piece in which it reported that members of a recommendation panel of the NCI accepted the findings of the Lancet study and planned to suggest mammography was in fact not valid as a lifesaving tool against breast cancer.

Many doctors were quick to jump to the defense of mammography -- and to criticize those who suggested it may not save lives. Breast cancer experts and organizations worldwide took out a full-page ad in the Times denouncing the study. On Jan. 31, the NCI issued a statement confirming its intention to stand firm in support of regular mammography screening.

"The benefit [of mammography] is there, and what women need to understand is that, even though it takes a long time to show that benefit in a study, each person, when their cancer is detected, has the benefit from the screening immediately," said Dr. Claudia Henschke, a radiology professor at New York Weill Cornell Medical Center. Henschke did a new analysis of the controversial findings, which was published in The Lancet on Feb. 2 and effectively refuted the earlier findings.

Henschke said she believes it's important that medical issues are debated and that women see all sides of a story. But in this case, she said, an invalid argument drove the debate from the start.

"They focused on insignificant things, and it should never have been blown so out of proportion… it created unnecessary anxiety when there was no real evidence," she said.

Today, doctors applauded Thompson's reaffirmation of the continued use of mammography.

"The concept is really quite simple: Mammograms find tumors at the very earliest stage, much sooner than they can be found in a manual or self-exam. And all the literature shows that the earlier you find a breast cancer tumor, the better your life expectancy," said Dr. Michael Cohen, director of breast imaging at the Memorial Sloan-Kettering Guttman Diagnostic Imaging Center in New York City.

Cohen added the smallest tumor that can be felt in an exam is about 2 centimeters in size, and that most women fail to find tumors until they reach 3 centimeters or more in size. By comparison, he said, a mammogram can find a micro-calcification in the breast, which is an irregularity so small it isn't even yet a tumor.

The doctors are hopeful that Thompson's statements, along with the recommendations of the USPSTF, will further bolster the validity of the NCI's decision to hold fast on this issue, and women will continue to get regular mammograms.

"When you summarize the trials of a half million or more individuals, the overwhelming evidence is that if you screen long enough, you can show the benefit, " Henschke said.

What To Do

To learn more about the mammography debate and the current position of the NCI, go here.

Find out how mammograms are performed and how they can help.

To find an accredited mammography facility near you, go here.

SOURCES: Interviews with Michael Cohen, M.D., medical director, Memorial Sloan-Kettering Guttman Diagnostic Cancer Screening Center, New York City; Claudia Henschke, M.D., professor, radiology, New York Weill Cornell Medical Center, New York City; Feb. 21, 2002, press conference with Tommy G. Thompson, Secretary of Health and Human Services, and Andrew von Eschenbach, M.D., director, National Cancer Institute, Washington, D.C.
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