Mammograms Still the Best Detection

Friday, March 9th 2001, 12:00 am
By: News On 6

WASHINGTON – Old-fashioned mammograms aren't perfect, but so far no new breast cancer detection system has proved better, concludes an exhaustive scientific review of tumor-detecting technology.

But other technologies may one day help catch more cancer, particularly in women with dense breasts, the Institute of Medicine reported Thursday, urging intensive research.

"Mammography is still the best way we have," said Dr. Janet Baum, a Harvard Medical School radiologist who co-authored the report.

Consequently, access to mammograms for uninsured women must be increased, the report said.

A program by the Centers for Disease Control and Prevention that gives free mammograms to the uninsured reaches only 15 percent of eligible women but should strive to quickly increase that number to 70 percent, the institute said. Additionally, a new federal law ensures Medicaid will pay to treat women whose cancer is detected in the CDC program, but states haven't yet adopted that change, the report said.

American women undergo 30 million mammograms a year. The breast X-ray, which costs $75 to $150, can detect early-stage tumors, when they're easier to treat. Routine screening mammograms can decrease breast cancer deaths by 25 to 30 percent, experts say.

But they're not foolproof. They sometimes miss suspicious spots that turn out to be tumors.

"The disappointing part of screening mammography is while it reduces mortality, it only does so by a fraction," said Dr. Daniel Hayes, breast cancer director at Georgetown University's Lombardi Cancer Center. "We think we can do better."

Last year, the Food and Drug Administration approved the first digital mammograms, computerized X-ray images that proponents tout because the computer images may be lightened or otherwise manipulated for a closer look.

For women, getting a digital mammogram is no different from getting one recorded on film, the breast is compressed and X-rayed the same way. And the institute, citing a continuing U.S. Army study of 7,000 women, says that so far, there's no evidence that digital mammograms are superior to film ones in spotting cancer.

So if a woman's doctor offers digital mammograms, she should be sure the physician is properly trained. And women should feel confident that it's an equally effective choice, but not feel it's necessary to search out the newer technology, Dr. Baum said.

Among the report's other findings:

• Some doctors use computer programs to double-check mammograms for suspicious spots. With less-experienced radiologists, studies suggest this computer re-check has potential, but nobody yet knows if it's worth wide-scale use or the cost.

• Other techniques, like testing breast fluid for precancerous signs, remain experimental and require large studies.

The Institute of Medicine is part of the National Academy of Sciences, an independent organization chartered by Congress to advise the government on scientific issues.