Dispute Builds Over Value of Mammography

By GINA KOLATA

dispute over mammography is growing, with Senate hearings planned, professional medical groups weighing in and others persuading expert panels to help them decide what to believe.

At issue is whether the breast cancer screening test, which has become a yearly ritual for millions of women, makes any difference in preventing breast cancer deaths.

In October, the British journal Lancet reported that despite a widespread belief that mammography saved lives, studies had found only a marginal benefit. In addition, the article's authors said they could point to flaws in those studies so troubling that the benefits of mammograms were unclear.

Last week, an independent panel that provides information used by the National Cancer Institute to inform the public said that in light of the new analysis it could no longer tell women that mammograms prevented breast cancer deaths.

This week, two senators said they planned hearings on the question.

One of them, Barbara A. Mikulski, Democrat of Maryland, has scheduled a Feb. 28 hearing of the public health subcommittee of the Health, Education, Labor and Pensions Committee, and the other, Tom Harkin, Democrat of Iowa, who heads the committee that determines appropriations for the National Institutes of Health, will schedule a separate hearing on the issue, his staff said.

Yesterday, 10 health organizations, including the American Academy of Family Physicians and the American Cancer Society, ran a full- page advertisement in The New York Times advising women to continue to have mammograms. "We have grave concerns that these public debates have already begun to erode the confidence in mammography that has been built up over the past two decades," they wrote.

The American Society of Clinical Oncology, announced yesterday that it was convening a panel of experts to assess the data. The United States Preventive Services Task Force, an independent but government-financed group that issues screening guidelines, is also preparing a report.

An article in The Lancet today says that, according to another new analysis, mammography screening prevents breast cancer deaths if studies go on long enough.

Other countries are wrestling with the issue. The Swedish Board of Health and Welfare is to meet this month to decide whether to continue national screening, and in March, a World Health Association panel is expected to take up the question.

Women, meanwhile, are flooding advocacy organizations with calls asking what they should do.

In their advertisement in The Times, the health organizations said: "While the existing studies of mammography screening have known limitations and even some flaws, the evidence as a whole solidly supports reduced breast cancer mortality rates due to mammography screening. Early breast cancer detection means a greater chance for successful treatment and a greater range of treatment options."

Others disagree. "The evidence is not strong enough to support regular screening mammograms," said Dr. Donald Berry, the head of biostatistics at M. D. Anderson Cancer Center in Houston and a member of the panel that voted last week to step away from its conclusion that the test prevents breast cancer deaths.

Dr. Peter C. Gotzsche, director of the Nordic Cochrane Center in Copenhagen, whose Lancet paper started the debate, said he had no regrets.

"Women have received a quite simple message until now — come early and then we can cure you," Dr. Gotzsche said.

Now, he said, at least some might start asking how to weigh the evidence of the benefits and the risks.

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