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Women Skeptical of Changing Mammography Guidelines

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WebMD Health News

June 5, 2000 -- First, we heard that women should get mammography screening every two years starting at age 40. Next, we heard that mammography has no clear benefit for women 40 to 49, and that they should decide for themselves. But, faced with a controversy over that policy, some in the scientific community have again begun recommending the tests for women in this age group.

In today's health care environment, many women cast a jaundiced eye at the debate and suspect that insurers' financial concerns are driving it.

In a study published recently in the journal Archives of Internal Medicine, researchers found that 95% of 503 women surveyed had paid some attention to the mammography controversy, but that only 24% felt the discussion had helped their understanding of the issue. Some 49% of the respondents said costs were the major reason for the change to the original guidelines, with some remarking that insurance companies or HMOs "don't want to pay for mammography."

But the controversy was really over mammography's effectiveness, says the study's author. "The reason experts were debating mammography for women in their 40s was because the scientific evidence supporting mammography for younger women is not as strong as for older women," Steven Woloshin, MD, MS, tells WebMD. "Regular screening mammograms reduce the chance that a woman in her 40s will die of breast cancer, [but] the size of this reduction is less than that afforded by mammography to older women."

Noting that the research supporting this change got buried, he says: "It is probably very important to try to separate science from politics and costs. ... Although early detection and screening make intuitive sense, we cannot know whether screening is truly beneficial until it has been studied in a randomized, controlled trial." Woloshin is an assistant professor of medicine and staff physician at the Veterans Affairs Medical Center in White River Junction, Vt.

Some breast cancer activists see the survey respondents' suspicions as understandable. The distrust of the health care system that causes people to see an economic benefit, rather than science, behind the change is attributable to "the milieu of the day," says Ceci Shapland, executive director of the Women's Cancer Resource Center in Minneapolis, and herself a breast cancer survivor.

"When I heard the information, my first response was [that] access to a test was being taken away from me, because I was in that age group at the time," she tells WebMD. She says the initial change in the guidelines should have been accompanied with information about what women in their 40s can do to screen for breast cancer -- breast self-examination.

"It was very interesting, but not very surprising, that the [respondents'] perception had more to do with their distrust of insurance companies and the cost of mammography rather than the scientific data," Hillary Rutter, ACSW, tells WebMD. She is the director of the Adelphi New York Statewide Breast Cancer Hotline and Support Program.

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