Officials Rebut Report that Mammography Is Not Effective in Saving Lives
WASHINGTON, March 06–Although Danish statisticians conclude in a recent report that mammograms are not essential to save lives, local and national specialists insist that regular screenings are necessary to detect most types of tumors, and to improve patients’ quality of life.
“Mammograms are an effective preventive tool,” said Dr. Ronald Charles, medical director at the Greater New Bedford Community Health Center. “I believe that the potential is there to save lives – if cancer is detected, then the person can be sent to the right place [for treatment]. The goal is early detection, and early treatment.”
Stacy Souza, a statistician at the Health Center, agreed. “If a woman [with a tumor] never got mammograms, she would never know she had the disease,” she said. “It could be a much greater issue 10 years down the road. It would go to the lymph [node], and metastasize.”
In a Senate hearing on Feb. 28, Dr. Andrew von Eschenbach, director of the National Cancer Institute (NCI), disputed a recent study by statisticians Dr. Peter Gotzsche and Ole Olsen of the Nordic Cochrane Center of Denmark. The report concluded that there was no reliable evidence to prove that mammograms save lives. But Dr. von Eschenbach said the data he has compiled indicated that they play a role.
In 1989, death rates from breast cancer began a decline of 1.4 percent a year; in recent years, he said, the decrease improved to 3.2 percent a year.
“We feel confident that mammography has contributed to this decline, but mammography alone has not driven this trend,” Dr. von Eschenbach told the joint hearing. “Advances in therapy, including adjuvant therapy (both hormonal and chemotherapy) and chemoprevention approaches (such as Tamoxifen) have also played a role. Unfortunately, the current debate appears to be focused on this single component in the equation.”
Accordingly, NCI continues to recommend mammography screening for women over age 40. But Dr. von Eschenbach said he believes women need unimpeded access to prevention, screening, treatment, and supportive care to win their battle against breast cancer. “We need to keep our focus on the sum of the equation: longer life coupled with better care.”
Although Dr. Charles was unsure if mammograms actually save lives, he said that it is essential for women to take advantage of mammograms at free clinics that are supported by the Massachusetts Department of Public Health’s Breast Cancer and Cervical Initiative. “If women don’t come into the health care system and take advantage of the free care program, then their chances of getting early detection are nil,” he said. Nevertheless, the Massachusetts Division of Health Care Finance and Policy found in an October 2001 study that insured residents are almost twice as likely to visit a doctor as an uninsured adult in the Fall River/New Bedford area.
Caucasians are more likely to develop breast cancer than African-American women, but blacks have a higher mortality rate, and nearly half – 47 percent – die within ten years of diagnosis, according to the Massachusetts Breast Cancer Coalition. Dr. Charles said that African-Americans have a higher mortality rate because of the lack of information about resources available to them. Of the clients at the Greater New Bedford Community Health Center, approximately 5 percent are black, and nearly 30 percent are Hispanic.
It was the debate over the need for mammograms that prompted. Barbara Mikulski, D-MD, to join with Sen. Tom Harkin, D-Iowa, in calling the joint hearing of two Senate subcommittees to clarify the effectiveness of breast exams and inform women of various options for treatment.
The hearings were held by the Appropriations Subcommittee on Labor, HHS and Education, which Harkin chairs, and the Health, Education, Labor and Pensions Subcommittee on Public Health, on which Mikulski, who authored the 1992 Mammography Quality Standards Act to ensure higher quality breast imaging, sits.
At least 203,500 invasive cases of breast cancer will be diagnosed this year, and 40,000 women will die of the disease, said Harmon J. Eyre, chief medical officer at the American Cancer Society. Nonetheless, Mr. Eyre said, progress is evident in detecting and treating the disease over the past two decades primarily because of mammography.
“We have reviewed the scientific evidence relating to mammography repeatedly since 1980, and we have continuously concluded that while improvements in technology are certainly welcome, mammography remains the best tool we currently have to detect breast cancer early,” he said. “Studies showed that detecting breast cancers early increases the chances of survival.”
Although most scientists agree that mammography is the best test to detect tumors, not all concur that screenings save lives.
“Women with breast cancer detected mammographically have extremely good prognoses in comparison with those having cancers detected in any other way,” said Dr. Donald Berry, chairman of the department of biostatistics at the University of Texas. “Mammographically detected tumors are smaller and are less likely to have spread to the axillary lymph nodes. Since women whose breast cancers were found by a mammogram do so much better, there is a tendency to attribute the benefit to mammography.”
But such an attribution may be incorrect, Dr. Berry said, because while the “apparent survival from diagnosis may be longer· life expectancy may not change at all.”
If scientists are uncertain that mammograms save lives, then clinicians should inform clients of this prior to a screening, National Breast Cancer Coalition president Fran Visco said at the hearing. “The issue is about saving lives, not saving the institution of mammography,” she said.
Ms. Souza, of the New Bedford Community Health Center, advises women to conduct self-exams at the onset of sexual activity or age 18, and to begin regular mammograms 10 years prior to the age of their mother’s, sister’s or grandmother’s diagnosis.
Written for the New Bedford Standard-Times in New Bedford, Mass.
