ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Friday, January 24, 1997 TAG: 9701240068
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: BETHESDA, MD.
SOURCE: Associated Press
RATHER THAN AGREE on whether women undergo their first tests for breast cancer at 40 or at 50, experts called research inconclusive and suggested that patients decide with their doctors.
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.''
Experts agree that mammograms starting at age 50 cut 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 research. One study showed breast cancer deaths decreasing by 44 percent among women who had mammograms in their 40s.
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.
Breast cancer strikes about 180,000 U.S. women each year, and is expected to kill 44,000 this year - about 10 percent of them under age 50.
In addition to mammograms' cost - $40 to $150 - as many as 90 percent of the abnormalities they uncover are benign. Women often undergo further testing that can be stressful and painful.
Still, federal surveys show 63 percent of women in their 40s have had a mammogram in the past two years.
``We are disappointed'' with the NCI panel's report, said the American Cancer Society's Robert Smith.
For a confused 40-year-old, the report ``is going to give her misinformation,'' said Dr. Stephen Feig of Thomas Jefferson University, who reported in December that annual mammograms could cut breast cancer deaths by 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.
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 15percent of cancers, and they are less sensitive in younger women. They also are uncovering more tiny tumors called ``ductal carcinoma in situ'' that don't always become life-threatening. Many experts think these women are overtreated, but there's no way to tell in advance who will be endangered.
The panel offers this guidance:
* Weigh your risk of breast cancer, considering whether close relatives have had it.
* Mammograms may find cancer early, when it's more curable.
* But more X-rays mean a greater chance of unnecessary biopsies to pin down benign tumors, plus exposure to radiation.
LENGTH: Medium: 81 linesby CNB