Published in the San Francisco Chronicle, March 28, 1997, page A4:

Consensus Advice on Mammograms: Institute Joins in Urging Tests for Women in 40s.

The National Cancer Institute reversed itself yesterday and recommended that women in their 40s undergo routine mammogram screening, a decision it hopes will lay to rest one of the most fractious national debates in recent medical history.

The institute, part of the federal National Institutes of Health, said women at average risk for breast cancer should be screened every one or two years beginning at age 40, and women whose risk is higher - such as those with a family history of the disease or a genetic predisposition for it - should consider having mammograms even earlier.

President Clinton, whose mother died of breast cancer, said the latest recommendations provide "clear, concise guidance," and he announced steps intended to make mammograms more easily available to the target age group.

The institute's announcement came four days after the American Cancer Society urged women in their 40s to have the procedure annually, a change from its previous recommendations of every one or two years. The cancer institute and the cancer society, regarded as the nation's two most influential cancer policymaking groups, issued a joint statement yesterday, saying their advice should be regarded as compatible.

The cancer institute's new policy defies the conclusions of a consensus panel convened in January by the National Institutes of Health. That panel said the evidence on mammography in younger women was equivocal, leaving the decision to each woman and her doctor.

The cancer institute has been under strong pressure from lawmakers, the medical community, and patient advocates to rescind a 1993 recommendation that women 40 to 49 years old do not need annual mammogram screening. At that time, the institute cited studies that found no difference in breast cancer death rates between women who began screening at age 50 and those who started earlier. But recent studies have found a reduction in breast cancer deaths among women in their 40s who had regular mammograms.

"There is no doubt that screening mammograms are capable of saving lives," Dr. Richard Klausner, the institute's director, said yesterday. "The question that has been difficult to resolve is when women should begin...We hope these new recommendations will clarify what has been a confusing issue for women in their 40s."

Clinton said the federal government will begin a national breast cancer education program to get the latest information to the public and to health care workers. He also said his administration will assure state directors of Medicaid, the health program for the poor, that federal money is available to help pay for mammograms for women in their 40s.

In addition, Clinton promised to require federal employee health insurance plans to cover the procedure for this age group, and he challenged private-sector plans to do the same. Some private plans do, but coverage varies. Mammograms generally cost $40 to $150.

Breast cancer is the most common form of cancer in women in the United States. It is the second most lethal cancer, after lung cancer, among women of all ages, and the leading cause of death among women ages 40 to 49. Last year, breast cancer was diagnosed in 184,000 women in this country; about 31,000 of them were 40 to 49.

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