BETHESDA, MARYLAND--The National Cancer Institute (NCI) has once again endorsed breast cancer testing for women in their forties. The action brings NCI recommendations in line with those of the American Cancer Society and other advocacy groups, but puts the agency at odds with an outside scientific panel that concluded recently that such tests do not save lives.
At a press conference here today, the National Cancer Advisory Board (NCAB) announced its support for mammograms every 1 to 2 years for women aged 40 to 49 with a normal risk of breast cancer. Such x-ray tests could save 1500 to 2000 lives a year, says NCI director Richard Klausner, although the board noted that a third of all diagnoses might be false alarms. Klausner praised the board's recommendation and said the policy would become effective immediately.
Although most experts agree that regular mammograms can reduce breast cancer deaths among women over 50, they have fiercely debated the value of universal screening for women in their forties. Clinicians who treat breast cancer patients are among the staunchest advocates of screening, while many epidemiologists find little statistical evidence for a benefit. In 1993, citing a lack of clear scientific evidence, NCI reversed its policy and decided not to recommend screening in that age group. In January, a 14-member expert panel sided with the epidemiologists and reaffirmed that stance after evaluating seven randomized trials.
But the NCAB came to a different conclusion, deciding that mammograms every 1 to 2 years reduce breast cancer mortality by about 17%. The benefit is "difficult to detect with a high level of certainty," admits NCAB chair Barbara Rimer, a behavioral scientist at Duke University, but she adds that universal screening is "scientifically defensible." The only dissenting voice on the 17-member board was epidemiologist Kay Dickersin of the University of Maryland School of Medicine.
The new policy does not apply to women in their forties with an elevated risk of breast cancer, those with a family history of the disease, certain genetic mutations, or who gave birth after age 30. Those women, says the board, should consult a physician for the appropriate interval for testing. The board reached its decision a month earlier than expected because of the public controversy stirred by the consensus panel's stance, Rimer says, but it didn't influence the outcome: "We did our work separate from all that." ACS officials applauded the new NCI policy and said it was consistent with their recommendation for annual screening of that age group.