
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, January 10, 1995                   TAG: 9501100077
SECTION: EXTRA                    PAGE: 1   EDITION: METRO 
SOURCE: JULIET WITTMAN KNIGHT-RIDDER/TRIBUNE
DATELINE:                                 LENGTH: Medium

GUIDELINES ON WHEN TO GET A MAMMOGRAM

Perhaps you've heard that the National Cancer Institute and the American Cancer Society disagree on the value of mammograms for women under 50. Meanwhile, your tofu-eating friends, the ones who believe all technology is evil, are urging you never to expose your tender flesh to avoidable radiation at all. You're completely confused. What should you do?

Here's my opinion: Mammograms save lives. If you're in your 50s, you should have a mammogram annually. In your 40s - just as the American Cancer Society says - you need have one only every two years, unless you feel a lump in your breast or your family is particularly prone to cancer.

Unfortunately for all of us, money considerations often shape health policy in this country. There's a huge industry that benefits from a call for universal mammography. And an even bigger one - the health insurance industry - that loses. There are profound suspicions in some quarters that, in downplaying the need for mammograms for women in their 40s a year ago, officials at the NCI were unduly influenced by politics. President Clinton's health care plan called for no coverage of mammograms for women under 50.

Now, however, a Swedish study has shown a sharp reduction in mortality among all women routinely screened.

The NCI hasn't revised its recommendation, but fortunately, you don't have to wait for them - and your insurance company shouldn't either.

Women who have had breast cancer sometimes ask me how early their daughters - who are at higher than average risk - should begin getting mammograms. It's impossible to answer this question. Though the alarmists may have overplayed the dangers of radiation (I believe mammography's benefits outweigh its disadvantages for middle-aged women), I don't think women in their 30s should utilize mammography routinely. And it seems to me highly dangerous to irradiate the developing tissues of teen-age girls.

You may also have heard that mammography standards vary. But as of October, a rigorous law went into effect in America, subjecting mammography to specific standards and making it illegal for any facility to operate without a federal certificate that requires annual updating.

All this said, be aware there's nothing magical about mammograms: They miss a certain percentage of cancers. They sometimes yield a highly ambiguous image. They're only as good as the person reading them - and reading a mammogram is more an art than a science. Radiologists viewing the same images can come up with completely different recommendations.

It's a tricky thing. When a doctor is too vigilant, the result is unnecessary biopsies; if he's complaisant, he may miss a cancer.

It's best to go to the same facility each time, so the radiologist can compare your current mammogram with the one taken a year earlier.

Make sure you get your results after a mammogram. Silence doesn't necessarily mean all is well - it may mean someone slipped up. And if there's a palpable lump in your breast, be sure to follow up with a doctor, even if your mammogram shows nothing suspicious.

Mammograms may be a crude diagnostic tool, but they're the best we have at present. Combine a regular mammogram with monthly breast self-examination and an intelligent lifestyle, and you'll know you've done everything possible to protect yourself.

Juliet Wittman is the science and health editor of the (Boulder, Colo.) Daily Camera, and the author of ``Breast Cancer Journal: A Century of Petals.'' (Fulcrum Publishing).

by CNB