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NIH Panel Assailed on Breast Cancer Screening

WASHINGTON--A blue-ribbon panel commissioned by the National Institutes of Health (NIH) to assess whether women in their 40s should receive mammograms has ducked the contentious issue of whether such a test should be recommended for all women in this age group. The panel concluded today that mammograms can extend the lives of women in this age group. But when it came to making a recommendation, the panel was stymied by evidence that the x-ray procedure can be unreliable and may trigger breast cancer in a fraction of those tested. Mammogram advocates later criticized the panel's uncertainty in a heated press conference at NIH, and sources at the National Cancer Institute told ScienceNOW that NCI director Richard Klausner was preparing a statement critical of the panel's conclusion.

The 13-member NIH consensus panel, chaired by Johns Hopkins epidemiologist Leon Gordis, heard 3 days of testimony from doctors, scientists, and patient advocates on screening for breast cancer, the leading cause of death in American women in their 40s. The panel concluded that "about 2500 women [in their 40s] should be screened regularly in order to extend one life." But it also cited estimates that the radiation women would receive from yearly mammograms between ages 40 and 49 is enough to cause one additional breast cancer death per 10,000 women. The panel also pointed out that the test fails to detect up to 25% of invasive breast cancers in 40-year-olds, and 10% of procedures give false alarms. Unable to judge whether the benefits outweigh the risks, the panel concluded that "at the present time, the available data do not warrant a single recommendation for mammography for all women in their forties."

"I'm astounded" at the decision, says Stephen Feig, chair of the American College of Radiology's committee on mammography screening guidelines and director of breast imaging at Thomas Jefferson University Hospital in Philadelphia. The panel "ignored the data," Feig says, referring in part to a study from his group that appeared recently in the journal Cancer. They found that screening women in their 40s could reduce breast cancer mortality by at least 35%. "And that's a conservative estimate," he contends.

The American Cancer Society also piled on, stating that the panel "did not go far enough in support of mammography in this age group." The society recommends that women begin receiving annual or biennial mammograms at age 40.