Medicine: Mixed Messages on Mammograms

• Share

More than any other disease of women, breast cancer symbolizes pain, mutilation and death. The disease strikes 1 woman in 10 and is the second leading cause of cancer deaths among females in the U.S., where it has the highest incidence in the world. This year 135,000 new cases will be diagnosed, and the disease will kill 42,000 women. Worse, its incidence is rising: last month the National Cancer Institute reported significant increases during both 1984 and 1985, the most recent period for which figures are available. Equally troubling, deaths from breast cancer among young and middle-aged women are increasing. Despite those sobering realities, an estimated 70% of American women still fail to undergo regularly scheduled mammograms, or breast X rays.

There are several reasons for their reluctance. Many women fear that the radiation itself will cause tumors, a risk that researchers consider negligible, since radiation doses are far lower today than they once were. Other women simply find the cost -- an average mammogram is $100 -- prohibitive. Most to blame, however, may be doctors themselves: for several years, the medical establishment has been sharply divided over whether younger women will benefit from mammograms. The debate was rekindled earlier this month by a report published in the Journal of the American Medical Association. In the study, Dr. David Eddy of Duke University and several colleagues found routine mammograms in women under 50 to be of so little benefit that women may not consider the screening worth the trouble. An accompanying editorial took the findings even further. Declared Dr. John Bailar III, a physician and medical statistician at McGill University in Montreal: "The evidence . . . does not demonstrate any clear health benefit from mammographic screening for breast cancer in women younger than 50 years . . . Routine screening of this age group should be discontinued."

The J.A.M.A. report, which was an analysis of five major studies of mammography, found that for every 10,000 women between 40 and 49 who have yearly mammograms for ten years, only 22 lives would be saved. The overall price tag would be considerable. Screening even a quarter of the 14 million women in the U.S. between 40 and 49 would cost $350 million. The practical result: few poor women are tested for breast cancer at all; middle-class women, too, balk at the cost, which many health-insurance plans still refuse to reimburse (though four states require insurers to cover at least some routine screenings).

Eddy's findings tend to undermine the recommendations of both the American Cancer Society and the American College of Radiology, which have suggested since 1983 that women undergo the procedure at least once between ages 35 and 40 as a basis for comparison with later mammograms, and then every year or two * between 40 and 49. But several other professional groups, including the American College of Physicians, have long chosen not to recommend screening by X rays for women under 50 except for those considered at high risk: women who have had breast cancer already or whose mothers or sisters have had the disease.