NCAB to Consider Mammography in Forties

BETHESDA, Md--After considering the politically charged and complexissue of mammography screening for women between ages 40 and 49, the NationalCancer Advisory Board (NCAB) created a special working group to craft arecommendation for the National Cancer Institute on what it might advisedoctors to tell these women.

Will Review Draft in the Spring

The eight-member NCAB Working Group on Mammography will write a draftover six to eight weeks for the full NCAB to consider and act on sometimethis spring.

NCI director Richard D. Klausner, MD, said he "trusts the wisdomand ability of the board," and anticipates that he will use the board'srecommendation essentially as the NCI's guideline to physicians and Americanwomen on this issue.

He emphasized that the NCAB's discussion was not a reaction to the preliminaryreport of the recent NIH Consensus Conference panel, which found

insufficient scientific evidence to recommend periodic mammograms forthis age group, but rather was planned nearly a year before as part ofan orderly process by NCI to assess the mammography issue, a process thatincluded the Consensus Conference. "The NCAB is our only advisorybody, not the consensus meeting," he added.

NCAB members Robert W. Day, MD, PhD, president of the Fred HutchinsonCancer Research Center, Seattle, and Frederick P. Li, MD, of the Dana-FarberCancer 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 conjunctionwith their physicians to decide whether they should undergo mammography.
• To suggest ways to best communicate this information to both patientsand physicians.
• To devise ways the board can better monitor the changes in data accumulatedby the seven ongoing studies looking at the effectiveness of mammographyin women ages 40 to 49.

"We are focusing as much on what NCI's next step needs to be ason trying to come to a statement of scientific evidence," Dr. Rimersaid. "We are going to look for ways to help women and their providersto make decisions."

Several board members and Dr. Klausner emphasized that any statementmust include a discussion about the uncertainty of the data on the benefitsof 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 conclusionbut the language of the report, which I thought did not give a balancedtone that would make it easy for women to make the most informed decision."

Dr. Klausner went on to say that he was indeed "shocked" atthe emotional level of the participants--the anger and accusations thatcharacterized the debate.

Internal Dissension

In other news, internal dissension within the consensus panel has emerged,with one member resigning (Jeanne Petrek, MD, a breast surgeon at MemorialSloan-Kettering Cancer Center) and another (Daniel Sullivan, MD, of theUniversity of Pennsylvania) saying he would not sign the final report unlessit better reflects the benefits and risks.

Neither of these "dissenters" suggested that screening mammographyshould be recommended to all women in their 40s but only that the draftreport overstates the risks of mammography while understating possiblesurvival benefits.

As this publication went to press, the American Cancer Society (ACS)was convening a panel to review the relevant data. The ACS currently recommendsthat women in their 40s be screened every one or two years.

The American College of Radiology (ACR) released a statement reaffirmingits strong support for mammography screening for women in their 40s, callingthe consensus panel's decision "regrettable and not in the best interestof American women in this age group."

The American Association for Cancer Research (AACR) took a differenttack, issuing the following statement: "The AACR does not believethat a single all-inclusive yes or no recommendation for mammography screeningwas intended to be generated by the Consensus Development Conference, norwould a single recommendation be in the best interest of women who fallinto 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 thepress before appropriate members of the scientific community, health careproviders, consumers, and other interested parties have had an opportunityfor review and comment."