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Controversial mammogram recommendations renew the debate

WASHINGTON — In 1997, a federal panel of medical experts recommended against routine mammograms for women in their 40s, sparking an uproar that led to congressional hearings and a unanimous Senate vote condemning the findings.

Now 12 years later, a similar drama is playing out around a different federal medical panel, which this week recommended against routine mammograms for women younger than 50, saying it is not worth subjecting some patients to unnecessary biopsies, radiation and stress.

The independent panel, the U.S. Preventive Services Task Force, also recommended against teaching women to do self-exams and concluded that there is insufficient evidence to recommend that doctors do them.

The findings underscore a decades-long debate in the medical community about the benefits and risks of routine breast cancer screening for younger women. The conclusions also plunge the nonpartisan, nonpolitical advisory panel into the middle of a strident Washington discussion about health care, which has included allegations from Republicans that the Democrats' proposed reforms would lead to reduced care for patients.

Rep. Frank Pallone Jr., D-N.J., announced Tuesday that his House health subcommittee will hold hearings on the mammogram issue next month. Other lawmakers from both parties suggested that the task force had been swayed by insurance companies that could save money if fewer screenings are performed.

"We can't allow the insurance industry to continue to drive health-care decisions," said Rep. Debbie Wasserman Schultz, D-Fla., who said earlier this year that she underwent treatment for breast cancer.

The recommendations also garnered harsh criticism from powerful medical groups including the American Cancer Society — which says it will continue to recommend regular mammograms for women older than 40 — and the Access to Medical Imaging Coalition, which warned that the findings would "turn back the clock on the war on breast cancer."

Many patient advocacy groups and breast cancer experts, however, praised the decision, arguing that politics have too often interfered with science when it comes to mammograms. Maryann Napoli, associate director of the Center for Medical Consumers, said breast cancer screening is frequently "used by politicians as a way to say they are for women," whether the underlying policy makes sense or not.

Research and policy decisions surrounding tests for early breast cancer have had a topsy-turvy history. When a National Institutes of Health panel said in 1997 that routine mammograms for women in their 40s were not worth the risks, the Senate voted 98-0 to urge the National Cancer Advisory Board to endorse routine screenings for that age group. The recommendation was adopted.

In addition, the same panel that issued this week's guidelines came down on the other side of the issue under different membership in 2002. The task force, a 16-member group of independent experts put together by the Department of Health and Human Services, concluded that the evidence then tilted slightly in favor of routine mammograms for women in their 40s.

The immediate impact of the new guidelines is unclear. Forty-nine states including Florida require insurers to cover mammograms for women 40 and older; Medicare also covers it.

Critics say the guidelines could be used to establish what insurance companies would have to cover. The research was started long before the health care debate began, but the timing of Monday's announcement led some to speculate that the two were related.

But Ned Calonge, who chairs the 16-member panel, denied that cost or the debate over health care reform played any role in the decision. "Cost just isn't a consideration when the task force deliberates," said Calonge, who is also chief medical officer for the Colorado Department of Public Health and Environment. Twelve of the task force members were seated during the Bush administration, and the remaining four were also chosen before George W. Bush left office, he said.

What do you think?

If you're a woman willing to talk about your own experiences with mammography and thoughts on the new guidelines for an upcoming Times article, please contact Health and Medicine editor Charlotte Sutton at

Controversial mammogram recommendations renew the debate 11/18/09 [Last modified: Wednesday, November 18, 2009 5:28pm]
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