Panel undecided on value of mammograms in 40s

BETHESDA, Md. (AP) — Cancer experts who were supposed to settle a furious controversy over whether women should start having mammograms at age 40 or age 50 decided Thursday to leave the decision up to patients.
But in an unprecedented move, the government’s top cancer official disagreed with his own advisers, saying he believes mammograms in the 40s can cut breast cancer deaths.
Expressing surprise at Thursday’s mammogram report, National Cancer Institute Director Richard Klausner said he will take the debate to a presidentially appointed cancer panel next month.
“It is a difficult problem,” Klausner said. But “my own view is that … there is a benefit in terms of mortality.”
Everybody agrees that mammograms starting at age 50 are vital, cutting breast cancer deaths by about 30 percent.
The controversy is whether women need testing any earlier. The American Cancer Society says yes, recommending mammograms every year or two starting at age 40. But the NCI in 1993 said there was insufficient scientific evidence to justify mammograms that young.
Thousands of women have been caught in the impasse, getting conflicting opinions from doctors and struggling to get insurance payments for earlier testing.
The NCI convened 13 cancer experts to weigh the issue again, in light of new mammography research including a study of women in Gothenburg, Sweden, that found women who had mammograms in their 40s cut breast cancer deaths by 44 percent.
But other studies were inconclusive or statistically insignificant, the NCI panel said. In general, mammograms showed no mortality benefit until women in their 40s had been followed for 10 years — raising questions of whether testing early in the decade or later was responsible, it said.
“Each woman should decide for herself,” the panel concluded, after her doctor helps her weigh whether the cost and the possibility of being frightened by benign tumors or lulled into a false sense of security are worth the possible benefit.
Still, insurance and managed-care companies should pay for a mammogram for any 40-year-old, the panel unanimously recommended.
“We are not saying there’s no benefit, we’re just saying the benefit might be small and might not occur until late,” said panelist Dr. Leslie Laufman, a Columbus, Ohio, oncologist.
Breast cancer strikes about 180,000 American women each year, and is expected to kill 44,000 this year — about 10 percent of them under age 50.
Why not err on the side of caution? In addition to mammograms’ cost — $40 to $150 — as many as 90 percent of the abnormalities they uncover are benign. To be sure, women often undergo stressful, somewhat painful further testing.
Still, federal surveys show 63 percent of women in their 40s have had a mammogram in the last two years.
“We are disappointed” with the NCI panel’s report, said the American Cancer Society’s Robert Smith.
For confused 40-year-olds, the report “is going to give her misinformation,” said Dr. Stephen Feig of Thomas Jefferson University, who reported in December annual mammograms could cut breast cancer deaths by some 35 percent in women in their 40s.
He accused the panel of “ignoring important data.”
But some panelists wrote that 2,500 women in their 40s would need regular mammograms to extend just one life.
However, the panel acknowledged few studies have been done on mammograms among black Americans, who get breast cancer in their 40s as often as white women, but have a 50 percent higher chance of dying from it.
Mammograms aren’t perfect, NCI’s Klausner cautioned. They miss about 15 percent of cancers, and they are less sensitive in younger women.