New Study Questions "Forty Something" Mammograms
From The Cancer Chronicles #18 ©1993 by Ralph W. Moss, Ph.D.
For years, the 'cancer establishment' has urged women in their forties to get routine mammograms. For example, the American Cancer Society's guidelines specify at least one mammogram every one to two years between the ages 40 to 49; and then once per year thereafter.
The idea behind mammography is appealing. After all, a safe and effective way of finding breast cancer early might save thousands of lives. But is mammography really safe? Or effective for "fortysomething" women?
From the start, there have been bitter struggles over this strategy. Dr. John Bailar, former editor of the Journal of the National Cancer Institute (JNCI), said in 1976, "There is a body of information that the benefits to women under the age of fifty may not be as great as was thought when the project was started" (NY Times, 3/28/76). Critics also questioned whether exposure to the radiation of mammography (small as it is) might not cause as many tumors as it finds.
Now, almost two decades later, Bailar's concerns seem to be in the process of being confirmed at NCI itself.
Recently, a Swedish study published by the NCI suggested some potential danger from exposing the female breast to ionizing radiation (JNCI, 10/20/93). Doctors at the famous Karolinska Hospital in Stockholm studied women who received massive doses of radiation therapy for benign breast disease between the 1920s and the 1950s. Admittedly, the doses these women received were many, many times greater those given by correctly calibrated mammography machines today. However, according to NCI's Charles Land, it is prudent to assume that there still is a small risk of some women developing radiation-induced tumors from today's mammography.
Does this mean women should panic and avoid mammograms? Land believes that for women over 50 or at high risk, benefits far outweigh risks. However, for the average woman in her forties, the study's findings, together with other evidence, seem to argue against routine mammograms.
In addition, a second report in the JNCI by Suzanne W. Fletcherof the American College of Physicians in Philadelphia throws additional doubt on the value of mammograms for women in their forties. For women age 40 to 49, they say, there appears to be no survival benefit to obtaining routine mammograms, as both ACS and NCI have vigorously recommended in the past. For women aged 50 to 69, however, this panel concluded that routine mammograms reduced the risk of dying from breast cancer. For women in their 70s or older there was insufficient evidence to draw conclusions. On 10/21/93, an advisory panel recommended that NCI not longer give advice on mammography, but simply lay out the facts and let people make their own informed decisions.