Amid the controversy about when women should start getting mammograms, experts say one fact is being overlooked: Millions of older women who could benefit from the breast cancer screening tests do not get them.
"Eighty percent of breast cancers occur in women over 50, and they are not getting mammograms as frequently as they need to be," Dr. Susan Blumenthal, deputy assistant secretary for women's health, said Tuesday.
Hampered by weak data and an imperfect screening technology, public health experts have been wrangling for several years about whether and how often women in their 40s should have mammograms. The debate may be nearing an end with activists widely expecting the National Cancer Institute this week to endorse mammograms for women in their 40s.
But many doctors, public health officials and breast cancer advocates interviewed said that while they welcome a resolution to the 40-something debate, it should not be the focal point of breast cancer prevention and policy.
Nobody questions the value of mammograms for women over 50. In fact, if all women age 50-69 got them regularly the breast cancer death rate in that group would drop by about 30 percent.
But many of those women do not get mammograms. Government data from 1993, the most recent available, shows that one third of women age 50 to 64 had not had a mammogram in the past two years. For women over 64, the figure was 50 percent.
Experts say reasons range from doctors' failure to recommend the tests to a lack of health insurance to women's misconceptions about breast cancer itself.
Women may wrongly fear that the radiation can harm them or that the X-ray itself will hurt. They may not understand that early detection of breast cancer enhances the chance of survival and minimizes the need for disfiguring surgery.
"The biggest barrier is that the doctor doesn't advise it," said Cynthia Pearson of the National Women's Health Network.
Early mammograms suggested for some
CHICAGO _ Women who are genetically susceptible to breast cancer should get annual mammograms between ages 25 and 35, earlier than recommended for other women, researchers said.
"We think this population is unique by virtue of their very, very high risk" and is likely to benefit from early mammograms, said Dr. Wylie Burke, lead researcher and director of the Women's Health Care Center at the University of Washington.
In today's Journal of the American Medical Association, the researchers recommended annual mammograms between 25 and 35 for women born with mutations in the BRCA1 and BRCA2 genes. The genes account for an estimated 5 percent to 10 percent of all breast cancer cases.
Research has shown that women with a flawed BRCA1 gene face about a 65 percent risk of ovarian cancer and an 85 percent risk of breast cancer. Women with BRCA2 mutations have a breast cancer risk similar to women with BRCA1, but only a 10 percent or less risk of ovarian cancer.
Doctors may recommend genetic testing for women with a family history of cancer.