Mammography News: You Heard It Here First … and It’s Still an Outrage!

By Cynthia Pearson

In November, many women were shocked to learn that a leading independent group of medical experts has determined that women in their 40s should not rely on mammography screening to save their lives. This message is a dramatic contrast to the advice most women in the U.S. have been hearing for more than 20 years: that women should be very fearful of breast cancer, and that early detection can save women’s lives through screening mammograms. The new guidelines are no surprise at all to NWHN members, however, who’ve had the benefit of reading our information and analysis about this issue.

The NWHN agrees with the U.S. Preventive Services Task Force’s (USPSTF) new recommendations be-cause mammography screening just doesn’t work very well in women before menopause. We all hoped that it would but, in 1993, it became clear from well-conducted studies that our hopes hadn’t panned out. Screening mammograms simply do not work well for detecting breast cancer among women in their 40s, and they do not work at all for even younger women (who have high levels of estrogen and progesterone levels and correspondingly dense breast tissue). The fact that most women didn’t know this, and were receiving falsely optimistic messages about the life-saving benefits of once-a-year mammography screening, has been incredibly frustrating.

The USPSTF did its job: its members looked at the evidence and made recommendations about the best preventive health care practices. The USPSTF told the truth about the research on mammogram’s benefits. As a result, women can get a better assessment about the value of this heavily promoted technology. Information is always a good thing and the NWHN is glad that more women now have access to reliable information about mam-mograms and breast cancer detection.

But, I’m not at all happy to have been proven right about mammograms — even though I took a lot of criticism for saying that the technology didn’t work as well as was thought, and for the NWHN position paper recommending against screening mammography for pre-menopausal women. The truth is, I’m outraged. We’ve known for 16 years about mammography’s shortcomings when it comes to detecting cancer in younger women. We have lost all that time, when we could have been investing in identifying something that works better to detect these cancers. What we need is the equivalent of a Pap smear for breast cancer detection. While Pap smears are far from perfect, the technology they use to identify cervical cancer works equally well in 18-year-olds and 68-year-olds. Finding such a detection tool for breast cancer is particularly vital, because a significant number of breast cancer cases occur in women under age 50.

Way back in 1993, the NWHN called for a better, more accurate, way to identify breast cancer. We wanted a screening system that didn’t use radiation, didn’t hurt, was easy to administer, and didn’t find too many false positives. I’m outraged that we have made so little progress in the last 16 years. While a huge amount of money has been spent on breast cancer research, far too little has been spent to identify truly effective screening methods. Health care reform won’t solve this problem overnight, but the new investment being made in comparative effectiveness research could reduce that chance that we’ll go down a similar path in the future: spending millions of dollars subjecting women to tests that lead to unnecessary treatment without being able to deliver on the promise of saving lives.

In the wake of the release of the USPSTF guidelines, many women have been rallying against the recommendations and demanding continued access to mammograms for women under age 50. The recommendations have been painted as a form of “rationing” by Republicans who oppose health care reform. Many women are upset that they might not be able to get a screening mammogram in the future. But the real problem is that, for almost two decades, women have been misled into believing that mammograms work better than they really do. Research indicates that screening mammography reduces breast-cancer mortality by 15% at most for 40-to-49-year-old women (some studies found no mortality reduction at all). It’s hard to accept that bad news about screening because breast cancer is a frightening disease and women do not want to be told that there is nothing they can do to protect themselves. We believe that this fear is fueling efforts to block health care reform and fund research that might actually help women.

If this situation makes you as angry as it makes me, I encourage you to do what I do: support the groups that aren’t afraid of the painful truth and that advocate for what women need. In addition to the NWHN, these include the National Breast Cancer Coalition, the Dr. Susan Love Research Foundation, and Breast Cancer Action. It’s an outrage that we still have to fight for a screening tool that truly meets the needs of women, but we’re not giving up.

For more background on the studies and NWHN’s work on this issue, see our Mammography Position Paper at:
http:// www.nwhn.org/healthinfo/detail.cfm? info_id=20&topic=Position%20Papers.

Here’s a link to the Task Force guidelines:
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

Read a transcript of my interview on National Public Radio:
http://www.npr.org/templates/story/story.php?storyId=120682781

Cynthia Pearson is the NWHN Executive Director