[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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