AACR Comments on Mammography Screening for Women Age 40 to 49

ABSTRACT: The following position statement was made by the American Associationfor Cancer Research in response to the press release on mammography screeningfor women 40 to 49 years old issued by the National Institutes of Health(NIH) Consensus Development Conference.--The Editors

"The American Association for Cancer Research (AACR), a scientificorganization consisting of 13,000 cancer researchers, recognizes the evolvingnature of scientific knowledge in the area of breast cancer screening andthe good-faith efforts of the NIH Consensus Development Conference on mammographyto determine the relative benefits of screening for women aged 40-49. TheAACR does not believe that a single all-inclusive yes or no recommendationfor mammography screening was intended to be generated by the ConsensusDevelopment Conference, nor would a single recommendation be in the bestinterest of women who fall into the 40 to 49 age group."

"Although the AACR has not had the opportunity to review eitherthe scientific data or the full draft report from this Consensus DevelopmentConference, we are strongly in favor of clearly defining the risks andbenefits for each patient, rather than generalizing about specific agesat which women should seek mammograms. It is especially critical in theinformed consent process that each patient understand her personal riskfactor(s) for breast cancer, the risks of the mammogram itself, and thepotential for false negatives and positives as well as the potential benefitsof the procedure."

Complexity of Issues Stressed

"The complexity of the question being addressed has increased asdata from recent studies performed in Sweden show a statistically significantbenefit of mammography screening in this age group in terms of a reductionin breast cancer mortality. These findings suggest that follow-up investigationsin the United States should be pursued to consider differences in boththe technology and the mammography reading process that may explain thedifferences in findings. It is particularly important to address the problemof false positives and negatives in such studies. The AACR would supportthe meticulous scientific analysis of such studies prior to the releaseof any final comprehensive recommendations on screening mammograms forthis age group. In addition, any recommendations from this or any futuregroup must give careful consideration to the issue of differential riskswithin this age group, since younger women's mammograms are more difficultto read and younger women generally tend to develop more aggressive cancers."

Process for Disclosing Findings Criticized

"Finally, the AACR is compelled to comment on the process employedfor the analysis and disclosure of findings from this Consensus DevelopmentConference. Any process in which scientists are charged with reviewingan evolving body of scientific data and making recommendations that mayhave a far-reaching effect on policy decisions, public perception, insurancecoverage, and in this case, breast cancer mortality, must involve rigorin terms of scientific review, the evaluation of the report, and the appropriateprocess of communication. It is unacceptable to announce findings and recommendationsto the press before appropriate members of the scientific community, healthcare providers, consumers, and other interested parties have had an opportunityfor review and comment. The premature release of controversial recommendationsbased on inconsistent data can only serve to slow scientific progress andcreate additional confusion and insecurity both in this group of womenand the general public."

"In summary, we recommend that critical research issues such asquality assurance in the interpretation of mammograms, breast cancer riskfactors, and the overall economic impact of early detection in this populationbecome the focus of the recommendations from this Consensus DevelopmentConference. The goal of this process should be to provide a rational andunderstandable basis for patients, physicians, hospitals, clinics, andpublic health departments that offer mammography on which to weigh thebenefits and risks in each specific case so that the individual patientmay make a personal choice about mammography based on truly informed consent."