Mammograms

This is Bob Doughty. And this is Sarah Long with SCIENCE IN THE NEWS, a VOA Special English program about recent developments in science. Today, we tell about the debate over a test used in the fight against breast cancer.

For many years, experts have suggested that women have breast X-ray examinations called mammograms. Many doctors say these X-ray examinations reduce a woman's chances of dying of breast cancer. In the United States, an estimated one of eight women will develop breast cancer during her lifetime. The risk increases as a woman gets older. The government has spent hundreds of millions of dollars to help pay for these mammograms.

A mammogram takes a detailed X-ray picture of the inside of the breast. The picture can show if a woman has abnormal tissue that could be cancer. Health experts have told women that early discovery could reduce their chances of dying of the disease. They say the chances could be reduced by thirty percent. These experts have said early discovery of cancer might prevent removal of the whole breast and other severe treatments.

However, some experts no longer give this advice. They now say there is not enough evidence to say that mammograms reduce deaths from breast cancer. They say early discovery of breast cancer does not always guarantee that the disease will not spread to other parts of the body. Many women and their doctors are left questioning what to do.

Mammograms can show an extremely small tumor. They can show cancer long before a patient suspects it. But now, some doctors say cells from even a very small tumor may threaten a woman's survival. They say a small tumor may not be an early tumor. They say cells from these cancers may already have spread to other parts of the body.

Some experts say long-term survival does not depend on the size of the breast tumor. They say survival depends on the aggressiveness of the tumor. If a tumor has already invaded other parts of the body, even the best treatment may not save the patient's life.

An independent committee advises the National Cancer Institute about cancer testing and prevention. For years, this committee has advised women to start having mammograms at about age forty.

Last month, the committee said it would no longer advise mammograms. Ten experts found problems in the studies that helped make mammograms an important cancer-fighting tool. The experts said these studies were not performed correctly. Some of the studies were started as early as Nineteen-Sixty-Three. At that time, some requirements for such studies were not as demanding as they are today.

However, the National Cancer Institute disagrees with the independent committee. The institute will continue to advise women in their forties and older to have mammograms every one to two years.

((MUSIC BRIDGE ))

Criticism of mammograms began to increase last October. At that time, the British scientific publication The Lancet reported on early breast cancer studies. The report said they show mammograms provide only a little protection against dying of breast cancer. It said there is not enough clear evidence to decide the value of mammograms.

Two scientists from the Nordic Cochrane Center in Copenhagen, Denmark wrote the report. They said five of seven earlier studies of mammograms have problems. They said possible mistakes in the records may have weakened the research. They also said health histories of women in one study may have contained mistakes.

The Lancet, however, now has published a more recent report on the subject. This report says a Swedish study confirms the value of mammograms. Their report says evidence developed in Sweden shows mammograms can provide long-term protection against death from breast cancer.

Health scientists are debating the conflicting evidence. For example, ten health advisory organizations placed an advertising message in The New York Times newspaper in late January. This ad advised women to continue having mammograms. The American Academy of Family Physicians and the American Cancer Society were among the groups that placed the ad.

Doctors who treat cancer belong to the American Society of Clinical Oncology. The society has organized a committee to study mammograms. The United States Preventive Services collects and prepares health information. The group is organizing a report. Two United States senators plan hearings on the issue.

Barron Lerner is a doctor at the College of Physicians and Surgeons of Columbia University in New York City. Doctor Lerner has written a book called "The Breast Cancer Wars." He says both supporters and critics of mammograms have provided valuable information.

Doctor Lerner says a woman's age can help her decide about mammograms. He says he will not advise women under fifty whether or not to have the test. He will continue to suggest a yearly mammogram for women ages fifty to seventy.

Many breast cancer experts still believe that mammograms can save lives. They say mammograms find more early cancer tumors than any other test. In the past twenty years, death rates from breast cancer have dropped. However it is not clear if this is the result of early treatment due to mammography, better treatment, better education or some other reason.

Millions of Americans have become activists against breast cancer. This activism began almost thirty years ago. In Nineteen-Seventy-Four, the wife of President Gerald Ford had an operation for breast cancer. At the time, there was far less public discussion of this kind of cancer than today. Then Betty Ford openly discussed her disease. She helped Americans learn and talk about breast cancer. Many women went to their doctors for examinations.

Today, activists work to increase money for breast cancer research. They demand better education and treatment for the disease. Activists include men and women, individuals and businesses. They may disagree about mammography or other issues. But they all share the goal of trying to save lives.

For example, a woman named Nancy Brinker started the Susan G. Komen Breast Cancer Foundation in Nineteen-Eighty-Two. It honors the memory of her sister who died of breast cancer.

The sisters had a close relationship while growing up in Peoria, Illinois. Later they lived far apart. However, they talked by telephone every day. Ms. Brinker says she still remembers the day her sister said she had a lump in her breast. This growth proved to be cancer.

Some of America's best doctors treated Susan Komen. But she died of the disease. After that, Nancy Brinker started her foundation. She decided to see if one person could make a difference in the struggle against breast cancer. During the past twenty years, this organization has worked hard to fight the disease.

The Komen foundation operates a telephone information line for patients and others. The foundation and allied organizations have raised more than two-hundred-forty-million dollars. The money helps provide research, education, examinations and treatment.

One of the events that the Komen foundation organizes is called "Race for the Cure." This year, more than one-million people will walk or run in the five-kilometer race. These events take place in more than one-hundred American cities and three other nations. They are held to raise money. Many other organizations and businesses also organize walks, races and other events to raise money for breast cancer research.

The wife of a seventy-five-year-old retired Army officer died of breast cancer several years ago. Since then her husband has taken part in two fund-raising events. Last year, he walked more than eighty kilometers to aid breast-cancer research and treatment.The retired officer said he did this to honor the memory of his wife. He said he also did it to protect the future of their daughter.

This SCIENCE IN THE NEWS program was written by Jerilyn Watson. It was produced by Cynthia Kirk. This is Bob Doughty. And this is Sarah Long. Join us again next week for more news about science in Special English on the VOICE OF AMERICA.