[Congressional Record Volume 140, Number 25 (Wednesday, March 9, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                SENSE OF CONGRESS TO SAVE WOMEN'S LIVES

                                 ______


                         HON. OLYMPIA J. SNOWE

                                of maine

                    in the house of representatives

                        Wednesday, March 9, 1994

  Ms. SNOWE. Mr. Speaker, today I address the National Cancer 
Institute's revision of its mammography screening guidelines for women 
in their forties. As co-chair of the Congressional Caucus for Women and 
as a woman, I want to express my extreme concern about the National 
Cancer Institute's statement that experts do not agree on the role of 
routine screening mammography for these women because randomized 
clinical trials have not shown a statistically significant reduction in 
deaths for women under age 50.
  I call on the National Institutes of Health to rescind its recent 
statement for mammography screening of women ages 40 to 49 and continue 
to issue new guidelines when clear evidence warrants a change. Today I 
am introducing a sense-of-Congress resolution to advance this view and 
to express the need for adequately designed and conducted studies for 
women ages 40 to 49 through mammography and other emerging 
technologies.
  As we embark on health care reform, the Congressional Caucus for 
Women's Issues has been particularly mindful of the need for 
comprehensive health care for women. I am reminded of an old adage that 
an ounce of prevention is worth a pound of cure. A recent study has 
concluded that many women are not getting basic preventive care. More 
than one-third of the women interviewed by the commonwealth fund had 
not had any routine preventive care services in the year before they 
were surveyed. Women reported that they lack information from their 
doctors. Public information is sorely needed on how women can prevent 
and protect themselves against illness and disease.
  Although the board of scientific counselors for the NCI's division of 
cancer prevention and control concluded that there was not a 
statistically significant benefit from routine mammography screening 
for women ages 40 to 49 after reviewing eight major studies, the 
National Cancer Advisory Board overwhelmingly voted to maintain 
existing guidelines. Nonetheless, the NCI chose to rescind guidelines 
for women in their forties based on what Dr. Broder stated were the 
``scientific facts.''
  That may be an accurate statement, but on what are these scientific 
facts based? On inconclusive evidence, on eight randomized clinical 
trials with too few women to prove a benefit for women in their 
forties. There have been no adequately designed and conducted studies 
of the benefit of screening mammography for women in this age group. 
For example, in the National Breast Screening Study of Canada, the only 
study designed to evaluate screening of women in their forties, the 
study was not completely blind and a disproportionate number of women 
with advanced cancers were allocated to the screening group, 
compromising the ability of the study to demonstrate a screening 
mammography saves lives, we are waiting until we have foolproof 
scientific evidence? I reject this option.

  I understand that the NCI considers itself a premier research 
institution. But, what kind of research are they performing? And on 
what are they basing their conclusions? Why, at this time, did they 
change their views, when there is no basis for denying the potential 
effectiveness of screening mammography for women in their forties? Why 
did they not come out and support clinical trials for women in this age 
group?
  I contend that a major reason is economic. It is less expensive not 
to routinely screen women in their forties. Instead of utilizing that 
ounce of prevention at their disposal, NCI has opted out of good sense 
and good science. Instead, it has changed its views based on inadequate 
evidence. For far too long, women have been shunted aside in medical 
research because of cost. This is no longer acceptable. With thousands 
of women dying of breast cancer each year, and with health care reform 
at its inception, we must assure women that adequate research will be 
conducted not only on finding a cure to end the scourge of breast 
cancer, but also on the effectiveness of early detection.
  Recently, the National Cancer Advisory Board passed a motion 
recommending that the NCI not involve itself independently in setting 
health care policy. When NCI rescinded its guidelines for women in 
their forties, a void in health care policy was created. Within the 
Government, decisions must be made as to how and where health care 
policy is set. Not only the quality but the length of lives depends on 
it. We must weigh in on the side of an ounce of prevention for women 
with breast cancer because we cannot afford to do otherwise. American 
women are entitled to no less.

                          ____________________