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Today in Your Health, confusion about how best to prevent disease. First, breast cancer. Millions of women under 50 are still not sure whether they should have mammograms. Almost a year ago, a federal task force said mammograms should be optional for them. That caused quite an uproar. And according to NPR's Richard Knox, studies published this year have kept that controversy going.
RICHARD KNOX: Two studies were published just last month. One says: Mammograms save fewer lives than we thought. Another says: No, they save more lives than we thought. And a third, published back in March, says: Mammograms don't save any lives at all. The experts can't agree, and patients don't, either.
Ms. CAROL RABINOVITZ: I just can't believe that anybody would say that people in their 40s shouldn't be getting mammograms.
KNOX: Carol Rabinovitz is a Massachusetts woman who's convinced mammograms saved her life. She doesn't think problems like false positive tests matter, even if they cause millions of women to get needle biopsies that turn out not to find cancer. In fact, she has no use for people who dwell on those downsides.
Ms. RABINOVITZ: Why that would be a downside - my God. If it is cancer, wouldn't you want to know? And if it isn't cancer, hooray. And so you were uncomfortable for a minute and a half.
KNOX: Veneta Masson doesn't agree with that at all. She's a former nurse-practitioner who stopped getting mammograms 10 years ago.
Ms. VENETA MASSON (Former Nurse Practitioner): I thought: Why am I doing this? There was no strong scientific basis for continuing with doing mammograms as a means of saving women's lives.
KNOX: In fact, her sister died of a breast cancer that was missed on a mammogram.
Ms. MASSON: I would say that mammography was a worthy attempt, but it's a failed attempt. Let's let it go.
KNOX: In their recommendations to American women, the experts are just as divided as the patients. Dr. Otis Brawley is the American Cancer Society's chief medical officer.
Dr. OTIS BRAWLEY (Medical Director, American Cancer Society): You've got the very pro-screeners who are upset and the very anti-screeners who are upset.
KNOX: The�Cancer Society still urges women under 50 to get regular mammograms, despite last fall's recommendation from the federal task force. That group analyzed all the studies and said getting regular mammograms should be optional for women under 50.
No matter how you read the studies, it's clear to many experts that mammography, at its best, reduces breast cancer deaths by only about 30 percent. Brawley says it's just not a very good test.
For example, colon cancer screening and Pap smears lower the cancer death risk two to three times more than mammography does.
Dr. BRAWLEY: You know, I get letters from women who've been diagnosed with stage four disease. I get several a week. And these are women who say, well, I got a mammogram every year. How could this have happened to me?
KNOX: The fact is mammograms miss a lot - up to 20 percent of all breast cancers.
Dr. BRAWLEY: If everybody in their 40s got screened every year, realize we're still going to lose at least 7,000 women per year in their 40s to breast cancer, despite mammography. We need something better than mammography.
KNOX: But that's some years away. Meanwhile, Brawley's message is...
Dr. BRAWLEY: Stay the course. Continue getting mammograms. But also realize mammography is not perfect.
KNOX: There's another point to keep in mind. Along with the modest benefit from screening mammography in younger woman, the harms loom larger for them. Dr. Ned Colonge, chairman of the federal task force, says they're more likely to have false positive mammograms, to undergo biopsies that turn out to be negative, and to be treated for cancers that may never cause a problem.
Dr. NED COLONGE (Chairman, Federal Task Force on Mammograms): That's why we think it should be in the hands of the woman herself. As the harms mount and with the relatively small potential benefit, a woman should understand that and make her own decision.
KNOX: Meanwhile, many women aren't paying a lot of attention to the squabbles among experts.
Ms. P.J. HAMEL: Frankly, most women used up their energy on this subject last year, and nothing has really changed.
KNOX: P.J. Hamel is a breast cancer survivor in Vermont. She's been talking to her friends about the recent studies.
Ms. HAMEL: The reaction is, you know, the scientists can't agree with one another. And so there's a lot of eye-rolling and just whatever, you know. We're just going to continue to get our mammograms.
KNOX: It's not a great tool for detecting breast cancer early, she says, but it's the best one we have right now.
Richard Knox, NPR News.
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