Mammogram
Advice in Dispute
Excerpt
By Lauran Neergaard, AP
WASHINGTON (AP) - It's advice that's almost become gospel: Getting
a mammogram could save your life.
Now some scientists are challenging whether that's true - and
the controversy is serious enough that even the National Cancer
Institute is reviewing its guidelines.
For now, the advice hasn't changed: Women should begin getting
mammograms in their 40s, stressed Dr. Peter Greenwald, the NCI's
cancer prevention chief.
But now two Danish scientists have reanalyzed those studies
and concluded they had so many flaws in the way they were conducted
that it's impossible to say whether mammograms really reduce deaths.
Those analyses are causing a scientific uproar, and many specialists
do not accept them.
``The bulk of the evidence at this point continues to endorse
mammography as a useful tool in potentially reducing one's risk,''
said Dr. Robert Young, president of the American Cancer Society.
Most scientists now discredit Dr. Young's thinking.
Still, the controversy is about to get more of a consumer airing.
This week, advisers to the NCI took up the issue, and agreed with
the Danes. This group, called the PDQ editorial board, is responsible
for updating scientific information on the government's main cancer
Internet site, and may add to the site by spring the warning that
mammography's lifesaving promise is in doubt and potentially harmful.
``That translates into, 'You should not make the decision lightly,'''
said Donald Berry of Houston's M.D. Anderson Cancer Center, a
panel member who is helping draft the opinion. ``It is something
that a woman can reasonably choose not to do and not feel that
she's harming her health.''
The cancer institute isn't bound by its advisers' opinions,
but is going to review its mammogram recommendations.
``We're going to take a look at this as efficiently as we can,
but it is complex and will take some time'' to settle, Greenwald
said.
Meanwhile, as to whether the controversy will discourage some
women from getting the tests, he said: ``I'm afraid that's true.''
But for some cancers, such as prostate cancer, early detection
has proved controversial. It's not easy to predict if men need
aggressive prostate cancer treatment or if they have one of the
forms of that disease that grows so slowly it will never threaten
them.
Now with breast cancer, ``what we're seeing is that the thing
we've believed for so long - that finding cancer early is good
- may not be right,'' Berry said. ``It may be that when we find
it either the cat's out of the bag or not, and if we had delayed''
the woman would have had the same outcome.
Everyone acknowledges mammograms aren't perfect. Many of the
abnormalities they uncover turn out to be benign, causing unnecessary
anxiety and additional testing. Also, better mammograms are uncovering
more tiny tumors called ``ductal carcinoma in situ'' that aren't
invasive cancer and don't always become life-threatening. Many
experts think such patients are overtreated, but there's no way
to tell in advance who will be endangered.
Some of the most provocative mammogram studies were performed
by Swedish researchers who are being urged to release all their
records so independent reviewers can decide if the data's truly
faulty.
In Britain and some other countries where far fewer women get
mammograms, new studies are under way that might help answer how
beneficial the testing is, Berry said.
And ``it is quite conceivable'' that in about 10 years, scientists
will have new tests that can tell if a mammogram-spotted tumor
is truly life-threatening or a slow grower, he said. For now play
seriously on the cautious side if any doctor prescribes a mammogram
to assess any potential disease.
Reference
Source 102
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