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STEVE INSKEEP, host:

It's MORNING EDITION from NPR News. Good morning. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

We're going to look, this morning, at the science and the politics of a recommendation on mammograms. Experts say women can wait until 50, not 40, for regular cancer screening. They say the earlier tests are not worth the benefit for most women.

INSKEEP: That prompted criticism of the advice, both medical and political. Republicans say it's evidence that President Obama wants to ration health care. So, Health and Human Services Secretary Kathleen Sebelius made a statement. She said government health programs will pay for mammograms exactly as before.

MONTAGNE: She even said women should, quote �keep doing what they have been doing,� which only deepens the questions.

We begin our coverage with NPR's Richard Knox.

RICHARD KNOX: Some people's reaction to the new guidelines was, it's about time. One of them is Dr. Susan Love. She's a former breast cancer surgeon who runs a Los Angeles foundation dedicated to finding the cause of breast cancer.

Dr. SUSAN LOVE (President, Dr. Susan Love Research Foundation, Los Angeles): I was never convinced that mammography screening worked that well in younger women, and have always suggested that women should start at age 50.

KNOX: Love says the idea that yearly mammograms are lifesaving for women in their 40s was oversold.

Dr. LOVE: I'm not saying that mammography will never find cancer under 50, it can find it. The question is, when you look at a large group of women, is it finding enough cancers at a point where it's making a difference in the outcome? And the answer is, in the studies, that it's not.

KNOX: But when Love expressed that view in the blog this week, it was not very popular. Have you lost your freaking mind? wrote one 42-year-old woman. How dare you? May God help you sleep at night for the death call that you have just trumpeted. P. J. Hamel has been seeing a lot of similar messages. She is a patient advocate and a blogger for a Web site called HealthCentral Network.

Ms. P. J. HAMEL (Advocate, HealthCentral Network): I have been getting a lot of vitriol. People exploding with rage, basically. How dare they, you know, deprive me of my life or try to deprive my daughter of her life, and things like that.

KNOX: Hamel finds herself pulled in two directions. She knows researchers deal in the statistics, but she identifies with the plight of individual women.

Ms. HAMEL: My heart is going out to all the women who I know will die because they follow these new guidelines. On the other hand, my mind is saying they've done the analysis, they've put these guidelines out there. They did their job.

KNOX: One thing you should know about P. J. Hamel. At the age of 47 she had a suspicious mammogram. A biopsy showed advanced cancer. That was eight years ago. Today, she's fine. Hamel says mammography saved her life. So, like many women, she doesn't understand why the guideline writers placed so much emphasis on the down sides of mammograms - the anxiety and unnecessary surgery that false alarms can cause.

Ms. HAMEL: It's almost apples and oranges, you know? Life and death is obviously very important, whether you're worried for a few days or whether you have some needless surgery, isn't that worth your life? To me it would be. To me it was.

KNOX: Hamel says she is going to keep telling women to get yearly mammograms, including women under 50. Robert Smith of the American Cancer Society says it's sticking with the current guidelines too.

Mr. ROBERT SMITH (Director, Cancer Screening, American Cancer Society): Because we not only have looked at the evidence of the task force looked at, but we also looked at newer modern data.

KNOX: For instance, he says a study from Sweden shows 48 percent fewer breast cancer deaths among women in their 40s who got regular mammograms. That's very different from the U.S. task force's estimate. It says mammograms only reduced breast cancer deaths by 15 percent in this age group. But Smith acknowledges that advocates may have given American women unrealistic expectations about mammograms.

Mr. SMITH: Have we oversold screening? You know, we say screening saves lives and that simple statement has been criticized as over-promising, and it does I suppose because I don't say screening saves lives but beware. We want women to understand the shortcomings of screenings but we don't want them to be dissuaded from doing it.

KNOX: If nothing else, the current uproar might give everybody a more realistic idea about the pros and cons of mammograms.

Richard Knox, NPR News.

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