Scientific Consensus Grows in the Mammogram Dispute

The recommendation Sunday from the American Cancer Society that women in their 40s undergo routine annual mammograms presages a similar advisory expected to be announced Thursday by the National Cancer Institute. Coming from the nation’s two most influential cancer policymaking bodies, these recommendations reflect a new and strong scientific consensus.

Neither health insurers nor doctors dispute the now-abundant evidence that for women 50 and older, regular mammograms reduce death rates by at least one-third. But cost-conscious health insurers have been arguing that for women 40 to 49 who are not specifically at risk for breast cancer, the benefits of regular mammograms do not clearly outweigh the risks.

Such thinking is based in part on a misconception that mammography exposes women to dangerously high levels of radiation. While this was once true, a modern mammogram, says Los Angeles breast surgeon Susan M. Love, “exposes a woman to the same amount of radiation as she would have gotten walking bare-breasted along the beach for 10 minutes at noon--or until stopped by an officer of the law.”

The second concern of critics is that mammograms create false positives for up to 15% of patients. But such errors can be detected through biopsies or, less intrusively, through newer procedures like ultrasound imaging. Moreover, as historian Bettyann Kevles shows in “Naked to the Bone,” her new study of medical imaging, hospitals can reduce false positives significantly if mammograms are read by more than one radiologist.

This is not to say, however, that the insurance industry is wrong to be concerned that recommendations may end up as costly legal requirements. A bill introduced in Sacramento last month by Assembly members Liz Figueroa (D-Fremont) and Valerie Brown (D-Kenwood) would require insurers to cover hospital stays of up to 48 hours for women undergoing mastectomies and even simple lumpectomies. The rigidity of the legislation may foster truly unnecessary hospital stays--for instance, for certain simple lumpectomies done in an hour under local anesthesia.

However, with mammograms the evidence of benefit is now indisputable. If health care providers embrace regular mammograms for younger women now, they can avoid the sort of divisive controversy that has dogged managed care’s attempts to cut costs. With breast cancer now the leading cause of death for women 40 to 49, it’s simply the right thing to do.