BETHESDA, Md--After considering the politically charged and complex
issue of mammography screening for women between ages 40 and 49, the National
Cancer Advisory Board (NCAB) created a special working group to craft a
recommendation for the National Cancer Institute on what it might advise
doctors to tell these women.
Will Review Draft in the Spring
The eight-member NCAB Working Group on Mammography will write a draft
over six to eight weeks for the full NCAB to consider and act on sometime
NCI director Richard D. Klausner, MD, said he "trusts the wisdom
and ability of the board," and anticipates that he will use the board's
recommendation essentially as the NCI's guideline to physicians and American
women on this issue.
He emphasized that the NCAB's discussion was not a reaction to the preliminary
report of the recent NIH Consensus Conference panel, which found
insufficient scientific evidence to recommend periodic mammograms for
this age group, but rather was planned nearly a year before as part of
an orderly process by NCI to assess the mammography issue, a process that
included the Consensus Conference. "The NCAB is our only advisory
body, not the consensus meeting," he added.
NCAB members Robert W. Day, MD, PhD, president of the Fred Hutchinson
Cancer Research Center, Seattle, and Frederick P. Li, MD, of the Dana-Farber
Cancer Institute, Boston, will co-chair the working group.
NCAB chair Barbara K. Rimer, DrPH, of Duke University Medical Center,
charged the working group with the following mission:
- To construct a message that women in their 40s can use in conjunction
with their physicians to decide whether they should undergo mammography.
- To suggest ways to best communicate this information to both patients
- To devise ways the board can better monitor the changes in data accumulated
by the seven ongoing studies looking at the effectiveness of mammography
in women ages 40 to 49.
"We are focusing as much on what NCI's next step needs to be as
on trying to come to a statement of scientific evidence," Dr. Rimer
said. "We are going to look for ways to help women and their providers
to make decisions."
Several board members and Dr. Klausner emphasized that any statement
must include a discussion about the uncertainty of the data on the benefits
of mammography screening for women in their 40s.
Earlier, during a radio interview on American University Public Radio,
Dr. Klausner denied press reports describing him as being "shocked"
by the consensus panel's findings. "I was not shocked at the report,"
he said. "What I said I was uncomfortable with was not their conclusion
but the language of the report, which I thought did not give a balanced
tone that would make it easy for women to make the most informed decision."
Dr. Klausner went on to say that he was indeed "shocked" at
the emotional level of the participants--the anger and accusations that
characterized the debate.
In other news, internal dissension within the consensus panel has emerged,
with one member resigning (Jeanne Petrek, MD, a breast surgeon at Memorial
Sloan-Kettering Cancer Center) and another (Daniel Sullivan, MD, of the
University of Pennsylvania) saying he would not sign the final report unless
it better reflects the benefits and risks.
Neither of these "dissenters" suggested that screening mammography
should be recommended to all women in their 40s but only that the draft
report overstates the risks of mammography while understating possible
As this publication went to press, the American Cancer Society (ACS)
was convening a panel to review the relevant data. The ACS currently recommends
that women in their 40s be screened every one or two years.
The American College of Radiology (ACR) released a statement reaffirming
its strong support for mammography screening for women in their 40s, calling
the consensus panel's decision "regrettable and not in the best interest
of American women in this age group."
The American Association for Cancer Research (AACR) took a different
tack, issuing the following statement: "The AACR does not believe
that a single all-inclusive yes or no recommendation for mammography screening
was intended to be generated by the Consensus Development Conference, nor
would a single recommendation be in the best interest of women who fall
into the 40-49 age group."
The AACR criticized the panel, however, for releasing its report prematurely:
"It is unacceptable to announce findings and recommendations to the
press before appropriate members of the scientific community, health care
providers, consumers, and other interested parties have had an opportunity
for review and comment."