March 1, 2002

Senators Hear From Experts, Then Support Mammography

By SHERYL GAY STOLBERG

ASHINGTON, Feb. 28 — Clearly piqued that the controversy over mammography has confused women, members of the Senate heard testimony today from experts on both sides of the debate and then pointedly threw their political support behind breast cancer screening.

"Mammograms should not be equated with nose jobs," Senator Barbara A. Mikulski, Democrat of Maryland, declared at the outset of a hearing this afternoon. "I believe that mammograms do save lives, and women should know when to get them."

The hearing, a joint session of two Senate subcommittees, featured as its lead witness the new director of the National Cancer Institute, Dr. Andrew von Eschenbach. Dr. von Eschenbach restated the federal government's position, announced last week, that women older than 40 should receive mammograms every one to two years.

That pleased lawmakers, including Senator Kay Bailey Hutchison, Republican of Texas, who recalled an earlier debate, in 1994, over whether women should begin breast cancer screening at age 40 or 50.

"I feel like it's déjà vu all over again," Mrs. Hutchison said, adding, "Everyone in this room knows that by early detection, we have saved lives."

Not everyone in the room, however, agreed. Among those testifying today was Dr. Donald Berry, chairman of the department of biostatistics at M. D. Anderson Cancer Center, who said recent scientific studies showed that the benefits of mammograms did not outweigh the risks, which include unnecessary surgery to remove tumors that might not have threatened a woman's life.

The senators asked Dr. Berry what he would advise women to do. He replied that, if it were his wife or daughter, he would simply present the pros and cons and support whatever decision she made.

That prompted a groan of frustration from Senator Tom Harkin, Democrat of Iowa, whose two sisters died of breast cancer.

"We're lay people; we're not scientists," the senator said. "We want to know, odds on, what's the best thing to do."

Senator Bill Frist, Republican of Tennessee and the only physician in the Senate, reminded the audience that Dr. Berry was a statistics expert and did not treat patients.

Annual mammograms have been a routine for many American women, but there has long been disagreement over whether they truly save lives. The debate was renewed in October, when a group of researchers in Denmark published an analysis that cited serious flaws in seven large breast cancer studies that doctors thought proved the benefits of breast cancer screening.

The Danish work, in turn, prompted a panel of American cancer experts, including Dr. Berry, to conclude in January that the benefits of mammograms might not outweigh the risks. Then, last week, the Bush administration tried to settle the matter, with its recommendation in favor of mammograms.

One issue that concerns the senators is how insurers will react to the controversy.

"I'm concerned that in this atmosphere of inconclusiveness, the insurance companies will use this as an excuse to wiggle out of reimbursement," Ms. Mikulski said.