WASHINGTON -- Upset and confused by recent government recommendations on mammography screening for breast cancer, female senators yesterday sharply questioned why President Clinton's health reform plan limits coverage of this important test to women 50 and older.
"Right now, we have been so schooled in believing we need a mammogram starting at age 40," said Sen. Barbara A. Mikulski. "Now to have a benefits package recommend something else is confusing and disturbing."
The National Cancer Institute announced in December that there was no compelling evidence to support the practice of routine mammograms for women under age 50.
The senators' concerns added to the debate over how health reform should deal with women's health needs, one of the focal points of the health reform debate.
In a related development, a study was released yesterday showing that abortion is covered by most private insurance plans, a finding that abortion rights advocates say will be a major tool in lobbying for coverage of the procedure in any national health reform plan.
The question of private insurance coverage is a pivotal one in the debate because abortion rights supporters contend that the Clinton plan -- which covers abortions -- merely conforms to what is already available to most women.
If Congress passed a reform plan without coverage of abortion, it would take away an existing benefit most women have, abortion rights groups argue.
Anti-abortion groups immediately denounced the study done by the Alan Guttmacher Institute, charging that the institute is biased because it favors legal abortion.
The abortion study and the issue of mammography screening dominated a hearing held by Ms. Mikulski on the impact of health reform on women's health care.
The Maryland Democrat was joined at different times by five other female senators, who spoke emotionally about breast cancer and how best to detect it.
Women received a jolt in December when the cancer institute, which had been recommending that women receive mammography screening beginning at age 40, announced the results of studies showing that mammograms do not reduce the breast-cancer mortality rate for women under 50.
An estimated 46,000 women will die this year of breast cancer, the most common cause of death for women ages 40 to 44, according to the institute.
Although many prominent groups like the American Cancer Society urge women in their 40s to continue to receive mammograms, the Clinton administration heeded the findings of the cancer institute in deciding not to include coverage for routine mammograms for women 40 to 49.
Officials of the institute and the Department of Health and Human Services sought to defend that decision before Ms. Mikulski's subcommittee on aging, but they failed to convince her.
Ms. Mikulski announced after the hearing that until there is more definitive evidence to the contrary, she believes that mammography screening for women in their 40s should be included in any health benefits package.
The mammography issue is an emotional one because of the deadliness and prevalence of breast cancer, and many of the senators' comments reflected this.
"What you are seeing is a deep frustration on the part of women," said Sen. Patty Murray, a Washington Democrat.
Sen. Dianne Feinstein, a California Democrat, continued questioning federal officials even after the hearing ended, declaring, "I don't quite understand how you are adding up the evidence" on mammography.
Sen. Barbara Boxer, a California Democrat, said she is "not willing to throw out a scientific diagnostic tool unless there is clear scientific evidence -- clear scientific evidence -- that it does not save lives. I don't think there is clear scientific evidence yet."
Dr. Phil Lee and Dr. Susan Blumenthal, top Health and Human Services officials, said studies showed mammograms of women in their 40s often produced inaccurate test results that caused women to undergo unnecessary biopsies, in which suspect tissue is removed and examined.
That risk -- and the hazard posed by exposing breasts to radiation from mammograms, which are X-rays -- should be weighed when considering the benefits of mammograms, the officials said.
The emotions aroused by the mammography issue overshadowed the abortion study by the Alan Guttmacher Institute, which found that two-thirds of health policies routinely cover abortion.
A spokeswoman for Blue Cross and Blue Shield of Maryland said the company treats abortion as an "approved surgical procedure" and covers it but does remove the benefit if an employer requests it.
Opponents of abortion cite evidence that private insurance coverage is "spotty," varying by region and health plan.
The National Right to Life Committee, an anti-abortion group which asked to testify yesterday before Ms. Mikulski's panel but was turned down, charges that abortion rights groups are trying to "force all Americans to pay the bill through mandatory" insurance premiums and taxes.
The Family Research Council, which did testify, observed that the "true status quo is that coverage of elective abortion in private health insurance is voluntary, not mandatory."