Women Skeptical of Changing Mammography Guidelines
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
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
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
"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.