WASHINGTON — In what is believed to be the first time that such a broad cross section of the nation's medical community has agreed on specific guidelines, 11 major health care and medical research organizations Tuesday recommended that all women without symptoms of breast cancer have regular mammograms starting at age 40 to screen for the disease.
"Mammography has been shown to be the most effective technique for detecting . . . the most curable form of the disease," said Dr. Gerald D. Dodd, former president of the American College of Radiology, one of the participating organizations. "It is critical that we educate women and their families about the importance of mammography."
Mammography, a painless low-dose X-ray of the soft tissues of the breast, has long been recognized as a valuable tool for detecting early breast tumors. But Dodd and other officials said that many groups in recent years have issued differing guidelines, which resulted in public confusion and a failure by many physicians to have their patients undergo the procedure.
The organizations, which include the American Medical Assn., the National Cancer Institute and the American Cancer Society, recommend a mammogram every one to two years for women 40 to 49, depending on their risk factors, and annually for women 50 and older. Risk factors include breast lumps and a family history of the disease, particularly if a mother or sister has suffered breast cancer. The coalition recommended that a physical examination accompany the screening procedure.
Breast cancer is the second-leading cause of cancer deaths in women in this country after lung cancer. About one in 10 women will develop breast cancer. The American Cancer Society has estimated that 142,000 new cases will occur this year and that 43,000 women will die of the disease.
A third of all breast cancers occur between the ages of 40 and 49. There are more than 15 million women between the ages of 40 and 50 in the United States, with nearly 35 million over the age of 50.
"Assuming that everybody had the examination, we could probably diagnose 90% to 93% of all new cases, at least half of those at the early stage," Dodd said. "This presumably would have a significant impact on mortality."
Although most organizations have been in general agreement that women should undergo mammograms, individual guidelines issued in recent years have differed "in detail, if not in substance," Dodd said. Some groups urged women to have a so-called "base line" mammogram at age 35. Other groups recommended routine mammograms for women older than 40, and still others suggested that annual mammograms were not necessary until a woman turned 50.
The American Cancer Society, in a 1986 survey, found that only 49% of primary care physicians had ordered mammography for women without symptoms. Further, only 11% of these physicians had followed the society's previously issued guidelines, which were similar to those released Tuesday. A 1987 survey sponsored by the National Cancer Institute indicated that only 17% of women older than 40 had had mammograms in the last year and that only 37% had ever had one.
"There's only one thing worse than facing the odds for breast cancer and that's having it and not even knowing it," said Dr. Charles P. Duvall, president-elect of the American Society of Internal Medicine, another of the groups in the coalition. "And that is what mammography is all about. Mammography is the only proven, reliable way to diagnose breast cancer in its earlier stages. We know lives can be saved this way."
The recommendations did not address the issue of self-examination, primarily because mammography can find tumors long before they can be felt. But representatives of the organizations said that self-examination remains an important element in the detection of the disease.
Dr. Charles R. Smart, chief of the early detection branch of the division of cancer prevention and control for the National Cancer Institute, said that, although women are now surviving longer after breast cancer has been diagnosed, the death rate has stayed the same. He predicted that this would change with more early detection of the disease. "We anticipate it (the mortality rate) should be going down in the next five to 10 years."
Costs Up to $125
The cost of mammograms can range from $35 to $70 in some facilities to $100 to $125 in others, Dodd said, adding that the procedure often costs more for women who have symptoms, such as a palpable lump. He said that 22 states, including California, have laws that mandate insurance coverage of mammograms. Also, in January, 1990, Medicare is scheduled to begin reimbursing women over the age of 65--in addition to the more than 1.1 million women covered under its disability provisions--for the procedure.
Other groups that endorsed the guidelines are the American Academy of Family Physicians, the American Assn. of Women Radiologists, the American Osteopathic College of Radiology, the American Society for Therapeutic Radiology and Oncology, the College of American Pathologists and the National Medical Assn.