[Congressional Record Volume 141, Number 31 (Thursday, February 16, 1995)]
[Senate]
[Page S2890]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


   SENATE CONCURRENT RESOLUTION 8--RELATIVE TO MAMMOGRAPHY SCREENING 
                               GUIDELINES

  Ms. SNOWE submitted the following concurrent resolution; which was 
referred to the Committee on Labor and Human Resources:

                             S. Con. Res. 8

       Whereas the National Cancer Institute is the lead Federal 
     agency for research on the causes, prevention, diagnosis, and 
     treatment of cancer;
       Whereas health professionals and consumers throughout the 
     Nation regard the guidelines of the National Cancer Institute 
     as reliable scientific and medical advice;
       Whereas it has been proven that intervention with routine 
     screening for breast cancer through mammography can save 
     women's lives at a time when medical science is unable to 
     prevent this disease;
       Whereas there are statistical limitations to evaluating the 
     efficacy of mammography in a 5-10 year age range of women, 
     using existing studies designed to test the efficacy of 
     mammography in a 25-30 year age range of women;
       Whereas there were numerous shortcomings identified in a 
     Canadian study designed to address reduction of mortality 
     from breast cancer in the 40-49 age range;
       Whereas to date, it is not possible to have the same degree 
     of scientific confidence about the benefit of mammography for 
     women ages 40-49 as exists for women ages 50-69 due to 
     inherent limitations in the studies that have been conducted;
       Whereas meta-analysis (combining the results of several 
     studies) is sometimes useful, and the studies used to reach 
     the National Cancer Institute's conclusions were not easily 
     combined because of variations in design, technology, 
     screening interval, the inclusion or exclusion of clinical 
     breast examination, and quality;
       Whereas the existing clinical trial data are inadequate to 
     provide a definite answer to the efficacy of early detection 
     in the 40-49 age group and there has been a dramatic change 
     in technology during the 30-year period since the initiation 
     of the first study of breast cancer screening;
       Whereas the majority, approximately 80 percent, of women 
     who are diagnosed with breast cancer have no identifiable 
     risk for this disease;
       Whereas breast cancer is the leading cause of cancer death 
     among women in the age group 15-54;
       Whereas the American Cancer Society and 21 other national 
     medical organizations and health and consumer groups are at 
     variance with the recently rescinded guideline of the 
     National Cancer Institute for mammography for women ages 40-
     49; and
       Whereas the statement of scientific fact on breast cancer 
     screening issued by the National Cancer Institute on December 
     3, 1993, will cause widespread confusion and concern among 
     women and physicians, erode confidence in mammography, and 
     reinforce barriers and negative attitudes that keep women of 
     all ages from being screened: Now, therefore, be it
       Resolved by the Senate (the House of Representatives 
     concurring), That it is the sense of Congress that--
       (1) adequately designed and conducted studies are needed to 
     determine the benefit of screening women ages 40-49 through 
     mammography and other emerging technologies;
       (2) the National Cancer Institute's statement of scientific 
     fact on breast cancer screening should clearly state that the 
     uncertainty of evidence for women in this age group is due to 
     the limitations of existing studies (as of the date of 
     issuance of the statement); and
       (3) the National Cancer Institute should reissue the 
     recently rescinded guideline for mammography for women ages 
     40-49 or direct the public to consider guidelines issued by 
     other organizations.

 Ms. SNOWE. Mr. President, breast cancer is the most common 
form of cancer in American women. One out of every eight women in the 
United States will develop breast cancer in her lifetime--a staggering 
increase from the 1-out-to-14 rate in 1960. An estimated 2.6 million 
women in America are living with breast cancer--1.6 million who have 
been diagnosed and an estimated 1 million do not yet know they have the 
disease. And every 12 minutes, a woman will die from breast cancer.
  We do not know what causes breast cancer, or how to cure it. Women 
with breast cancer are dying at the same rate today as they did in the 
1930's, and the same basic methods of treatment are being used--
surgery, chemotherapy, and radiation. Clearly, we need to promote 
research into the cause of, optimal treatment of, and cure for breast 
cancer.
  However, another importance weapon in fighting the battle against 
breast cancer is detecting breast cancer in its early stages. Survival 
rates drop dramatically the later the disease is diagnosed. And one of 
the most important tools for early detection is mammography, a low-dose 
x ray used to examine a woman's breasts.
  Recognizing the important of consistent guidelines on breast cancer 
screening, the American College of Radiology convened a series of 
meetings in 1987. As a result of those meetings, in June 1989, 12 U.S. 
medical organizations including the American Medical Association, the 
American Cancer Society, and the National Cancer Institute endorsed 
breast cancer screening guidelines which advised that asymptomatic 
women should begin having mammograms at age 40.
  However, in 1993, the National Cancer Institute rescinded its 
guidelines stating that there was no evidence that the examinations 
significantly reduced breast cancer deaths in that age group. It seems 
clear, upon closer inspection, that studies used to reach the National 
Cancer Institute's conclusions did not warrant a rescission of the 
guidelines because there were significant variations in design, 
technology, screening intervals, the inclusion or exclusion of clinical 
breast examination, and quality between studies. Furthermore, the 
National Cancer Institute's statement has caused widespread confusion 
and concern among women and physicians, eroded confidence in 
mammography, and reinforced barriers and negative attitudes that 
discourage women from seeking mammograms.
  Consequently, I am introducing this resolution expressing the sense 
of the Congress that adequately designed and conducted studies are 
needed to determine the benefit of screening women ages 40 to 49 
through mammography and other emerging technologies, that the National 
Cancer Institute's statement on breast cancer screening should clearly 
state that the uncertainty of evidence for women in this age groups is 
due to limitations of studies conducted prior to the rescission of its 
guidelines, and that the National Cancer Institute should reissue its 
guidelines.
  Hopefully, by reducing the barriers which presently discourage women 
from seeking mammograms, the adoption of this resolution will add to 
our limited arsenal of weapons to fight breast cancer.


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