[Congressional Record Volume 140, Number 51 (Tuesday, May 3, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        SENATE RESOLUTION 208--RELATING TO MAMMOGRAPHY SCREENING

  Mr. COHEN (for himself and Ms. Mikulski, Mrs. Hutchison, Mr. 
Grassley, Mr. Stevens, Mr. Bradley, Mr. Brown, Mr. Jeffords, Mr. Ford, 
Mr. Burns, Mrs. Murray, Mr. Specter, Mr. Reid, Mr. Mack, Mrs. Boxer, 
Mrs. Kassebaum, Mrs. Feinstein, and Ms. Moseley-Braun) submitted the 
following resolution; which was referred to the Committee on Labor and 
Human Resources:

                              S. Res. 208

       Whereas breast cancer is a substantial health problem in 
     the United States, and the leading cause of death in women 
     between the ages 15 to 54;
       Whereas breast cancer is the most common form of cancer for 
     women in the United States, and the second leading cause of 
     cancer death among all women;
       Whereas it is estimated that in 1994 alone, over 182,000 
     new cases of breast cancer will be diagnosed and over 46,000 
     women will die as a result of breast cancer;
       Whereas in 1992, 40,000 cases of breast cancer were 
     diagnosed in women under the age of 50, of which 28,900 cases 
     were diagnosed in women between the ages of 40 and 49;
       Whereas the risk of breast cancer increases significantly 
     after the age of 40;
       Whereas mammography is recognized as a valuable diagnostic 
     technique for screening women for breast cancer and has been 
     proven to reduce mortality for women over the age of 50 with 
     breast cancer;
       Whereas the National Cancer Institute is the lead Federal 
     agency for research on the causes, prevention, diagnosis and 
     treatment of cancer, and whose statements are relied upon by 
     health professionals and patients for critical health care 
     decisions;
       Whereas the National Cancer Institute in 1987 developed 
     guidelines recommending that breast cancer screening begin by 
     age 40 and consist of annual clinical examination with 
     mammography screening performed at 1- or 2- year intervals to 
     age 49;
       Whereas on December 3, 1993, the National Cancer Institute 
     released a statement on breast cancer screening for women 
     over the age of 50 that states that ``there is a general 
     consensus among experts that routine screening every 1 to 2 
     years with mammography and clinical breast examination can 
     reduce breast cancer mortality by about one-third for women 
     ages 50 and over'';
       Whereas such statement departed from the earlier 
     recommendations of the National Cancer Institute on 
     mammography screening for women ages 40 to 49 by stating that 
     ``experts do not agree on the role of routine screening 
     mammography for women ages 40 to 49'' and that ``to date 
     randomized clinical trials have not shown a statistically 
     significant reduction in mortality for women under the age 
     of 50''; and
       Whereas significant disagreement among experts in the field 
     of oncology over the interpretation and accuracy of recent 
     clinical studies on the value of mammography for women under 
     age 50 and the recent statement by the National Cancer 
     Institute on mammography for women ages 40 to 49 has sent 
     both confusing and conflicting messages to women at risk of 
     breast cancer: Now, therefore, be it
       Resolved, That it is the sense of the Senate that--
       (1) it is good public health care policy that appropriate 
     mammography screening be available and accessible for women 
     between the ages of 40 and 49;
       (2) in light of the scientific disagreement regarding the 
     value of mammography screening for women between the ages of 
     40 and 49, it is critically important that women and their 
     doctors decide what is the best course of care for the early 
     detection of breast cancer, including mammography screening;
       (3) health plans be established in such a manner to ensure 
     that all women, including women ages 40 to 49, receive 
     coverage for mammography screening that is appropriate for 
     the early detection of breast cancer;
       (4) comprehensive health care reform include adequate 
     protection of all women, including women ages 40 to 49, to 
     ensure that all women have access to coverage for mammography 
     screening where it is appropriate for the early detection of 
     breast cancer;
       (5) the National Cancer Institute supports additional 
     research, which may include randomized clinical trials, for 
     mammography screening for women ages 40 to 49 to determine 
     the effectiveness and benefits of mammography screening for 
     reducing breast cancer mortality in women under the age of 
     50;
       (6) the National Cancer Institute increase research to 
     improve imaging techniques such as mammography, and to 
     develop new types of early detection such as digital 
     mammography, and other technologies that will improve early 
     detection of breast cancer in all women, especially for women 
     ages 40 to 49; and
       (7) the Public Health Service, in conjunction with national 
     and international centers, consumer groups, and appropriate 
     medical and professional organizations, should immediately 
     reach a consensus on the studies that should be undertaken to 
     provide information to determine the effectiveness and 
     benefits of mammography screening and other emerging 
     technologies for women ages 40 to 49.

  Mr. COHEN. Mr. President, today together with Senators Mikulski, 
Hutchison, Grassley, Stevens, Bradley, Brown, Ford, Jeffords, Burns, 
Murray, Specter, Reid, Mack, Kassebaum, Boxer, Feinstein, and Levin, I 
am submitting a sense-of-the Senate resolution addressing the 
controversy surrounding the National Cancer Institute's recent policy 
statement questioning the effectiveness of mammography screening for 
women between the ages of 40 to 49. This resolution underscores that it 
is crucial to ensure that women between the ages of 40 to 49 have 
adequate access to mammography screening for the early detection of 
breast cancer. It also encourages the Public Health Service to work 
with national and international groups in determining what additional 
scientific studies should be conducted to test the effectiveness of 
emerging cancer screening technologies.
  Despite promising scientific advances in the diagnosis and treatment 
of breast cancer, this very serious disease remains a major health 
threat to millions of American women. This year alone, over 182,000 new 
cases of breast cancer will be diagnosed and more than 46,000 women in 
the United States will die as a result of this devastating disease. 
Breast cancer is the most common cause of death for women aged 40 to 
44. Indeed, since the current probability is that one in every eight 
women will be diagnosed with breast cancer, few families across this 
Nation will be untouched by this life-threatening disease.
  With statistics this somber, I am very concerned by the recent 
announcement of the National Cancer Institute that it will no longer 
recommend that breast cancer screening begin at age 40 and consist of 
annual exams and mammograms every year or 2 years up until age 49. This 
announcement has, in effect, reversed the NCI's guidelines on 
mammography that have been in place since 1987.
  The NCI's new position comes in the midst of great debate over the 
scientific basis for routine mammograms for women under 50, and before 
any adequately designed study has definitively established that 
mammography screening is not advisable for women in this age group. The 
NCI's action has been strongly opposed by over 20 national 
organizations dedicated to women's health, cancer prevention, and 
cancer research, such as the American Cancer Society and the American 
Medical Women's Association.
  The NCI's new position is highly controversial even within the 
National Institutes of Health itself. While the NCI determined, based 
on eight clinical trials, that there was insufficient evidence to show 
that mammography reduces mortality rates for women in their forties, 
only one of these studies was adequately designed to specifically 
evaluate screening for women in this age category. Moreover, this new 
policy was announced despite the advice of the NCI's own National 
Cancer Advisory Board--an extremely rare occurrence. By a 14 to 1 vote, 
the Advisory Board concluded that the Institute's earlier guidelines 
should remain in place because the science is inconclusive to support 
any changes at the present time.
  Mr. President, there has been widespread speculation on why the NCI 
has altered its position on mammography for women under 50, against the 
advice of its own board and a host of providers and advocates for 
women's health. Some women's groups, health care organizations, and 
doctors allege that it is economics, rather than scientific information 
that is leading this change in policy. They are concerned that the 
NCI's decision may have been influenced by the costs of reimbursing 
mammograms for women aged 40 to 49 if mammography is included in a 
standard benefit package under health care reform.
  I am not convinced that this was the motive behind NCI's action. I 
do, however, seriously question the wisdom of scaling back mammography 
standards for women during a time when the incidence of breast cancer 
has reached epidemic proportions and no clear consensus on this issue 
has been reached.
  I am very concerned that the NCI's action will send a confusing 
message about the importance of mammography, thus discouraging younger 
women to obtain screening. This mixed message is particularly 
disturbing at the same time that breast cancer treatment studies have 
come under fire for allegedly covering up possible falsification of 
data.
  I am also very concerned that the NCI's action has already had an 
adverse effect on insurance coverage for this important cancer 
screening tool, and that some insurance plans are now refusing to cover 
mammograms for women in this age group.
  There are exciting new developments emerging through cancer research, 
including blood tests and digital mammography to more accurately detect 
breast cancer. Until these alternative screening techniques are widely 
available, however, mammography remains one of the only weapons we have 
to help detect breast cancer during its first stages. Since early 
cancer detection offers the best opportunity for treatment to be 
successful, it is critical that we send the appropriate public health 
message to women: namely, that women of all ages at risk of breast 
cancer and women over the age of 40 should have access to, and should 
consult with their physician about routine mammography screening.
  This year, over 900 women in Maine will be diagnosed with breast 
cancer, and over 225 women will die as a result of this disease. 
Alarmingly, as many as 80 percent of these women have no known risk 
factor for cancer, but will still develop the disease.
  Recently, I met with a group of courageous breast cancer survivors 
from Maine who were visiting Washington to draw attention to the 
magnitude of the breast cancer epidemic in this country.
  Bonnie Tucker, a third generation breast cancer survivor, from 
Hampden, ME, was one of these survivors. Her grandmother was diagnosed 
with breast cancer at age 66 and her mother was diagnosed at age 48--
and died at age 50. Bonnie's own cancer was diagnosed at age 39, and 
she has no doubt that the mammogram that detected her cancer has added 
years to her life. She is furious with the NCI's recent policy 
statement and fears that many women without a family history of breast 
cancer may defer mammography until their cancer is too advanced, as in 
the case of her mother and grandmother. Bonnie is still fighting her 
own disease, and is fighting the battle for a cure for her daughter and 
millions of other young women in this country.

  Mr. President, as we tackle health care reform, we must do all we can 
to encourage preventive health care, as one of the most effective means 
of controlling costs in the long run. A key factor in preventive health 
care is educating patients on early disease detection and encouraging 
them to discuss screening techniques with their doctors. Clarifying the 
importance of mammography for women in their 40's is an important step 
in this direction.
  This resolution is endorsed by the American Cancer Society, American 
Medical Women's Association, National Breast Cancer Coalition, National 
Alliance of Breast Cancer Organizations, National Medical Association, 
American College of Radiology, American Society of Internal Medicine, 
Cancer Research Foundation of America, American Association of Women 
Radiologists, the Society for the Study of Breast Disease, Cancer 
Awareness Programs, and the Susan G. Komen Foundation.
  Mr. President, some have argued that we should not politicize science 
by intruding upon the actions of the National Cancer Institute, and 
that we should, instead, allow the science to speak for itself. I share 
this concern that we should not allow politics to dictate our 
scientific findings. This resolution, however, does not alter the 
scientific conclusions of the NCI, but rather clarifies that, in the 
absence of definitive scientific evidence to the contrary, we cannot 
afford to discourage women from seeking out early breast cancer 
screening.
  I applaud Senator Mikulski for her leadership in promoting quality 
mammography screening. Both she and I look forward to working with our 
colleagues, the NCI, and a host of major national cancer, health, and 
women's organizations in encouraging early detection of breast cancer. 
I urge my colleagues to cosponsor this sense-of-the-Senate resolution 
to send a strong, clear message that mammography is an important cancer 
screening tool which should be encouraged and available. To do any less 
could jeopardize the lives of millions of American women.
  I ask unanimous consent that a list of the groups that support the 
resolution be printed in the Record.
  There being no objection, the list was ordered to be printed in the 
Record, as follows:

                   Groups Who Endorse the Resolution

       American Cancer Society.
       American Medical Women's Association.
       National Breast Cancer Coalition.
       National Alliance of Breast Cancer Organizations.
       National Medical Association.
       American College of Radiology.
       American Society of Internal Medicine.
       Cancer Research Foundation of America.
       American Association of Women Radiologists.
       The Society for the Study of Breast Disease.
       Cancer Awareness Programs.
       Susan G. Komen Foundation.

  Mr. FORD. Mr. President, I rise today in support of this resolution, 
Senate Resolution 208, that is so vitally important to the women of 
this Nation. Breast cancer is a most horrible disease, it strikes all 
generations and is unrelenting in the attack on its victims. If there 
is anything that can be done to stop it, we must pursue that effort 
with all the resources that we possess.
  Mr. President, there is something that we can do. A properly 
performed mammography can help catch this dreaded disease in its early 
stages, when changes are highest for a full recovery. It is not 
perfect, it is not 100 percent effective, but it is a start. However, 
relaxed new guidelines on when women should begin routine mammography 
screening could put this valuable preventive medicine out of reach. 
Passage of this resolution will demonstrate how wrong the Senate feels 
these new guidelines are.
  This is not the solution to the greater problem, but it is a positive 
first step in the fight against breast cancer, and I say again, the 
least that can be done. It is with that sentiment that I ask my 
colleagues to join me in my support for this most meaningful 
legislation.
  Ms. MIKULSKI. Mr. President, I rise to join Senator Cohen in 
introducing Senate Resolution 208. We are introducing this resolution 
to express the sense of the Senate with respect to mammography 
screening to detect breast cancer in women. And we encourage our 
colleagues to join us in our efforts.
  Why a resolution on mammography?
  Because women and men across the country are angry about the mixed 
and confusing messages about the benefits of mammography for women 
between the ages of 40 and 49.
  Because they are concerned that without clear scientific agreement 
about the value of mammography screening for women aged 40 to 49 that 
insurance companies will take that as a sign to stop covering this 
procedure.
  Because they are concerned that there isn't sufficient research being 
done on the benefits of mammography in younger women or enough research 
being supported to improve early detection techniques that could better 
detect breast cancer in younger women.
  And because they are concerned that coverage for mammography 
screening in health care reform may not be adequate to the task of 
screening women to save lives.
  On April 9, I held a hearing of the Subcommittee on Aging to discuss 
women's health and health care reform. This was a historic hearing: six 
of the seven women Senators attended that hearing and all of them 
raised serious concerns about the confusing message coming from the 
National Cancer Institute regarding the value of screening women 
between the ages of 40 and 49.
  Last fall the National Cancer Institute after a serious review of the 
studies on mammography concluded that while there was a general 
consensus among experts that routine screening and clinical breast 
examination can reduce mortality for women over 50, there is no 
agreement among experts about the role of routine screening from 
mammography for women ages 40 to 49. They found that studies to date do 
not show significant reduction in mortality for this age group.
  The National Canter Institute also said that it was no longer issuing 
guidelines regarding mammography. Instead they issued a statement of 
their findings and encouraged women to discuss with their physicians 
appropriate health care regarding the early detection of breast cancer.
  The problem was that scientists of the highest caliber disagreed 
about the NCI findings. Respected physician groups also divided over 
the issue of whether women under the age of 50 should be screened 
regularly as had been the NCI recommendations from 1987 through 1993.
  And consumer health groups are divided as well about what to 
recommend to their constituents.
  That is why we need this resolution: we need more research, more 
cooperation, and a better way to communicate change in scientific 
guidelines to women in this country. We need a clear, scientific, and 
agreed upon course of action to reach a clear message. And we need to 
be sure that that process has input from consumer groups, appropriate 
medical and professional organizations, and national and international 
researchers.
  We also need an NCI that can lead, that can be trusted, and that can 
understand the fears and anger of women and men in this country over 
the rising rate of breast cancer and the lack of clear scientific 
agreement on how to best detect this disease.
  We know breast cancer continues to be the second leading cause of 
cancer death in women in the United States behind lung cancer. We know 
that 182,000 new cases of breast cancer are estimated to be diagnosed 
this year, 40,000 of which will be diagnosed in women under the age of 
50. And we know sadly that 46,000 women will lose their lives to this 
disease alone this year.
  That makes this resolution all the more urgent. We cannot retreat 
from the need to understand and find a cure for this disease. Nor can 
we retreat assuring that women get the type of care that is appropriate 
for the early detection of this disease in the face of scientific 
uncertainty.
  This resolution makes sure that we go forward--not backward.
  It makes clear that women between age 40 and 49 will get appropriate 
screening for the early detection of breast cancer.
  It makes clear that any health care reform bill must provide adequate 
and appropriate coverage for the early detection of breast cancer.
  And it makes clear that it is time that NCI take the leadership and 
bring all players to the table to reach a consensus on the studies to 
be taken to determine the effectiveness and benefits of mammography 
screening and other emerging technologies for women ages 40 to 49.
  The women who are dying from breast cancer every year are more than 
statistics. They are women of all ages, mothers, sisters, daughters, 
and granddaughters. We owe it to them to redouble our efforts on all 
fronts to eliminate this disease.

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