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Cursing messenger instead of message


AFTER CAREFUL study, an interdisciplinary panel of experts named by the National Institutes of Health decided that it could not recommend that women in their 40s have regular mammograms.

Instead, the panel advised women to weigh the evidence themselves, discuss it with their doctors and then make their own choice.

At best, this is not a helpful conclusion. The panel members read more than 100 scientific documents and heard testimony from 35 experts. How are we supposed to decide if they could not?

At worst, the panel has given reluctant women another reason to delay and postpone what, for any one of them, might be the right choice. Early detection is a cornerstone of cancer treatment, and few enough people choose routine cancer screening as it is. The panel did not advise against regular mammograms for women in their 40s, but that is what women will hear if they are looking for a reason not to have one done.

The panel's decision not to decide was greeted with shock and anger from every quarter.

Women and doctors alike expected advice, not an admission of confusion. Breast cancer is a hugely psychological and political health issue, and by choosing not to endorse the one thing a woman can do to protect herself from disfigurement and death, the panel appears to deserve the scorn of so many.

But we are cursing the messenger when it is the message we despise.

The data is ambiguous, the panel concluded. Women have been oversold on the notion that breast cancer can be cured if detected early and that mammograms can detect cancer at this curable stage. The data does not support this.

In addition, the incidence of false positives is high enough -- and the surgical consequences of investigating those false positives severe enough -- to balance any benefits.

It is not the fault of the panel that research does not support a recommendation in favor of regular mammograms after the age of 40.

But it is the fault of science that we are no better at diagnosing breast cancer -- let alone curing it -- than this. And that should be the source and the object of our anger and our scorn.

Mammography is just one weapon in the arsenal against breast cancer, and it is not an adequate one. It is just a picture -- often as cloudy and inconclusive as this panel's finding. We are furious that the medical community will not endorse this for us when we should be furious that this is all there is.

To have a mammogram or not is only one of the choices women must make in the battle against breast cancer.

The other is this: Do we just sit around and wait for better science to simply happen? Is all this ambiguity OK with us? Or do we demand better studies, better diagnostic tools, better treatment?

We wanted answers from this blue-ribbon panel, and we didn't get any, and we are frustrated and angry, and we feel betrayed.

Women have been shortchanged, but not by this panel. I suspect its members, many of whom were women, wanted very much to say that yes, mammograms save lives.

The villainy here is in the medical community and the research community, which has for too long assigned too few dollars, too little time, to a disease that terrorizes women and then kills them.

Pub Date: 2/09/97

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