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U.S. Offers New Guidelines for Mammogram Screening : Health: The federal recommendations are designed to help women feel at ease with breast cancer exam. Results within 10 days is another goal.


WASHINGTON — Federal health officials Wednesday released new guidelines governing mammography screening for breast cancer in an effort to enhance its effectiveness and to reduce the anxiety often experienced by women who undergo the procedure.

One recommendation, for example, is that mammography facilities ensure that women receive the results of their screening within 10 days.

Many women never get results or receive them late because of "communications breakdowns or confusion as to who will deliver" them, Health and Human Services Secretary Donna Shalala said at a news conference. "Such errors are unacceptable" and can cause treatment delays when cancer is present or undue worry over what turns out to be a normal reading, she said.

"It had never been clear whether mammography facilities or referring health care providers were responsible for telling women their results. Now it is," said Dr. Lawrence W. Bassett, Iris Cantor professor of breast imaging at the UCLA School of Medicine, who chaired the panel of experts that compiled the recommendations.

The guidelines recommend "that facilities notify women of their results, and also make sure that they are referred to a primary care provider for follow-up if they have come into the facility without one," he said. "Closing the communication loop between referring health care providers, women and facilities only makes sense."

The recommendations also strongly urge women to refuse screening by any facility that has not been certified by the Food and Drug Administration. Each facility should display prominently--or have available--an FDA certificate.

Quality standards for mammography were required by a law passed by Congress in 1992 and the deadline for certification was Oct. 1. Facilities lacking such certification are operating illegally.

The recommendations do not address how often and at what age women should undergo the procedure. In recent years, a debate has erupted over the effectiveness of mammograms in reducing the death rate from breast cancer in women between the ages of 40 and 49.

Nevertheless, most medical experts continue to believe that women 40 to 49 should have the procedure every one to two years and--since risk increases with age--annually after the age of 50.

The guidelines also offer advice to medical workers on ways to be sensitive to women who often are nervous about the process.

There will be an estimated 182,000 new cases of breast cancer in American women this year and 46,000 deaths. Breast cancer is the second-leading cause of cancer deaths in women.

Experts have estimated that regular mammograms--an X-ray that can detect tumors years before they can be felt--could reduce breast cancer deaths by one-third. Nevertheless, a majority of American women fail to undergo regular screening, according to the American Cancer Society.

The average cost of a mammogram is $89 but prices can range from $50 for a routine "screening" mammogram to $250 for a "diagnostic" mammogram for women with symptoms.

The guidelines, which were released by the Agency for Health Care Policy and Research, part of the U.S. Public Health Service, are expected to be widely disseminated to health care providers. They are not mandatory but are regarded by medical providers as the "standard of care."

They were praised by a range of medical organizations Wednesday, including the American Cancer Society, the American College of Obstetricians and Gynecologists and the American College of Radiology.

"We have known for some time that the benefits of mammography are compromised if women are not screened routinely, if the results of their examinations are miscommunicated and if there is poor communication between her health care providers," said a cancer society statement.

"Inattention to these important details may result in a missed opportunity to diagnose and treat her breast cancer early."

The guidelines stress that mammograms are not perfect and that monthly self-examination and a physical examination of the breasts by a health professional also should be considered part of effective breast cancer screening.

The panel said that mammograms should only be performed with modern, high-quality equipment and with film processors set up specifically for the mammography film being used.

It also said that all personnel performing services--from the technician who takes the picture to the radiologist who reads it--should be qualified through training, experience, certification and licensing.

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