New mammogram guideline draws criticism


DALLAS -- Women ages 40 to 49 don't necessarily need to undergo regular mammograms, according to a proposed new recommendation from the National Cancer Institute.

A panel of physicians and researchers is urging a change in the institute's mammography guidelines, recommending that women get mammograms every one to two years beginning at age 50. From age 40 to 49, the institute advises women to consult their doctors.

Current guidelines from the National Cancer Institute and other agencies recommend routine mammograms, which are used to detect breast cancer, every one to two years beginning at age 40.

The new recommendation will be published today in the Journal of the National Cancer Institute. The guidelines will not be made final until early December, after the National Cancer Institute seeks comment from other agencies.

In studies that followed women age 40 to 49 for five to seven years, "randomized controlled trials consistently demonstrated no benefit from screening," says the report from the International Workshop on Screening for Breast Cancer, a group assembled by the cancer institute to study the issue. The report also says that women who were monitored for more than 10 years seemed to show only a marginal benefit, if any, from having mammograms in their 40s.

However, regular mammograms are a great benefit to women ages 50 to 69, the report says.

The recommendation drew vigorous opposition from many doctors, who interpreted the data differently.

"We're surprised," said Dr. George Peters of the Baylor Sammons Cancer Center in Dallas. "We're bewildered. We're shocked. We cannot understand how this decision was made."

The decision was not made lightly, said Dr. Barbara Rimer, a committee member and an author of the proposal.

"None of us came in with our minds made up," Dr. Rimer said. "Everybody in the group agonized over it."

She said that eight large international studies conducted since 1963 found no benefit for routine screening in women younger than 50. The studies altogether involved more than 500,000 women.

"We were really forced to conclude that the data just don't support an effect for women 40 to 49," said Dr. Rimer, who is director of cancer prevention, detection and control at the Duke Comprehensive Cancer Center in Durham, N.C.

Dr. Peters says he fears insurance companies will use the new guidelines, whether they are adopted or not, as a justification to stop paying for mammograms for women under age 50.

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