Women's Health Advocate: Mammograms Aren't Always Helpful

A new flash point in the health care debate focuses on controversial recommendations for cancer screening for women. The U.S. Preventive Services Task Force, a government-appointed panel of independent experts, advised against annual mammograms for women under 50 and said can even skip a year between examinations. Guest host Jennifer Ludden speaks with Cindy Pearson, the executive director of the National Women's Health Network, for more.

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JENNIFER LUDDEN, host:

A new flashpoint in the health care debate is over controversial recommendations for cancer screening for women. The U.S. Preventive Services Task Force, a government appointed panel of independent experts, last week came out against annual mammograms for women under 50. And it said those above 50 should get the test only every other year.

The American Cancer Society, among other groups, flatly rejected that advice. A few days later, the American College of Obstetricians and Gynecologists recommended reduced screening of young women for cervical cancer. Both efforts have left many women confused about when and how often they should be screened.

Joining me now to talk about the new guidelines is Cindy Pearson. She's executive director of the National Women's Health Network. And she's here in our Washington Studio, welcome.

Ms. CINDY PEARSON (Director, National Women's Health Network): Thank you.

LUDDEN: Cindy, your organization welcomed these new guidelines for mammograms. Tell me why.

Ms. PEARSON: We actually think that women's health will be improved in the United States if we seek a better balance of bringing in the relatively few women who still aren't screened at all - so that's where the health reform bills are important to us - and taking a step back and screening a little bit less, the women who are already in the system. There's ways in which women's health gets hurt by too much screening.

LUDDEN: And - go ahead.

Ms. PEARSON: It's counterintuitive. It's hard to understand and it really contradicts the very simple messages that we've been getting all along, but it is important.

LUDDEN: Well, you said in your Web site that in 1993 already it was shown that, quote, �mammography screening doesn't work well for women before menopause and not at all for women under 40.� Now as someone who goes in very religiously every year and, you know, feels panicky if I get behind, that was news to me.

Ms. PEARSON: That's right. And that's why we didn't jump for joy when the news came out on Monday, but we did have an element of pleasure and happiness because we wanted women to finally get a more full understanding of what mammography screening can and can't do. And we don't want any woman ever to have the feelings that you've had, oh my gosh, I'm behind and I'm letting myself down. I'm letting my loved ones down.

Mammography screening is not like buckling your seat belt. It's not an absolute no brainer that if you do it, it'll save your life. And if you don't, you are careless and thoughtless. It's just not that.

LUDDEN: You know, your organization has actually been calling for quite a few years for some better technology that might be more accurate, you say something more like a Pap smear. Well, what do you envision and why don't we have that?

Ms. PEARSON: I think we don't have that because what worked initially in the first test in the 1960s - this approach of using x-rays to look inside the breast tissue and try to determine whether there is a lesion, a small tumor or precancerous changes. It worked in the first study, so all the efforts since then were to make it better. But it comes up against an impossible barrier that it's just never going to leap over, which is that at early ages, women's breast tissue is sensitive to radiation and can actually cause cancer. We know that now, clearly. It's not a controversy any more. So there's a�

LUDDEN: Too many mammograms can actually cause cancer earlier on?

Ms. PEARSON: Probable, probably not because as we age, our breasts become less sensitive and the level of radiation that's used is very, very small now. But it would never be able to be used as a screening technique for women in their teens, 20s or 30s. Cancer isn't very common there, but boy, is it real. It happens. And those women deserve a screening technique, just like women who've been looking at cervical cancer screening have had access to a screening technique that works equally well when they're a teenager or a grandmother.

LUDDEN: Now the calls for reduced screening have prompted cries of rationing. This is what Republican Congresswoman Marsha Blackburn from Tennessee had to say.

Representative MARSHA BLACKBURN (Republican, Tennessee): This is how rationing begins. This is the little toe in the edge of the water, and this is where you start getting a bureaucrat between you and your physician.

LUDDEN: Cindy Pearson, how do you respond to that?

Ms. PEARSON: Rationing exists in this country right now. It exists in the experience of women who get free screening and then can't get treated because they don't have insurance. I've talked to women who needed to come up with a very, you know, high amount of money just to finish the diagnostic process. We've all seen stories of women who had their treatment interrupted because they've lost their insurance or their insurance has met its limit. That's rationing. That's right now.

This attempt to balance how much screening is the right amount is an attempt to move forward in a scientific and medically sound way to finding what's best overall.

LUDDEN: Now, when we talk about African-American women, though, there is a bit of a different story, that they are more likely to get breast cancer earlier.

Ms. PEARSON: Yes.

LUDDEN: So what do these guidelines mean for them?

Ms. PEARSON: For African-American - young African-American women have, in many ways, been out in the cold for the last 16 years, because they are more likely to get cancer diagnosed before age 40 than any other group of women in the United States. And there is no good screening technique for women under age 40. We've tried to use clinical breast exams and teaching breast self exam. Those worked somewhat. But they're not great.

And so all these years, we should have been really taking it as a top priority to look for something that works in a completely different way so that these women, as well as the rest of young women, would have some sort of reliable screening technique to turn to.

LUDDEN: We have just a few seconds left, but as you watch the health care bills work their way through Congress, what do we know so far about what they would say about these kinds of preventive screenings?

Ms. PEARSON: They would take away any co-pays which is a great step forward, so there's not a barrier of having to pay part of the cost. And they would give women access to screening on a schedule that's been decided by a group of physicians, educated consumers and researchers. So we would have a public discussion going forward about what is the screening schedule for this and any other kind of�

LUDDEN: And do you see these new recommendations really influencing that debate? I guess we're off on that one already.

Ms. PEARSON: Yeah, they would, they absolutely would as they should.

LUDDEN: Cindy Pearson is the executive director of the National Women's Health Network. Thanks so much for coming in.

Ms. PEARSON: You're welcome.

(Soundbite of music)

LUDDEN: Just ahead, the argument for and against issuing drivers' licenses to illegal immigrants.

Mr. KEITH JOHNSON (Dean, Davis School of Law, University of California): If you have a license, then you've been subjected to some kind of safety testing. And I prefer that all drivers on the road, documented or not, have that safety testing, and that's why we have licensing laws.

LUDDEN: That's coming up on TELL ME MORE from NPR News. I'm Jennifer Ludden.

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