[Congressional Record Volume 143, Number 12 (Tuesday, February 4, 1997)]
[Senate]
[Pages S928-S934]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




CONCERNING THE NEED FOR ACCURATE GUIDELINES FOR BREAST CANCER SCREENING

  The PRESIDING OFFICER. Under the previous order, the Senator from 
Maine and the Senator from Maryland are recognized to speak for up to 
15 minutes each, followed by a time reserved for Senator Specter from 
Pennsylvania for 10 minutes.
  The clerk will report.
  The legislative clerk read as follows:

       A resolution (S. Res 47) expressing the sense of the Senate 
     concerning the need for accurate guidelines for breast cancer 
     screening for women between the ages of 40 and 49.


[[Page S929]]


  The PRESIDING OFFICER. The Senator from Maine.
  Ms. SNOWE. Mr. President, I yield myself such time as I may consume.
  The PRESIDING OFFICER. The Senator from Maine is recognized for such 
time as she may consume under the previous order.
  Ms. SNOWE. Mr. President, I rise to offer a sense-of-the-Senate 
resolution in conjunction with my colleague, the Senator from Maryland, 
Senator Mikulski, who has been a longtime advocate, proponent of 
advancing women's health in America. We responded to the January 23 
decision that was made by the advisory panel to the National Cancer 
Institute that recommended that women should refrain from having 
mammograms in their forties.
  I want to thank the majority leader, Senator Lott, the assistant 
majority leader, Senator Nickles, and Senator Jeffords, chairman of the 
Labor and Human Resources Committee for their assistance in getting 
this resolution to the floor so quickly. I would also want to thank the 
Democratic leader and my friends on both sides of the aisle for 
allowing us to consider this resolution under a unanimous-consent 
agreement. Breast cancer is an issue that transcends party and 
politics.
  My resolution expresses the sense of the Senate that NCI should 
conduct studies to determine, once and for all, the true benefit of 
mammograms for women in their forties. It also urges the Advisory Board 
to NCI, which will meet later this month, to consider reissuing the 
mammography guideline it rescinded in 1993 recommending that women in 
their forties seek routine mammograms. NCI must put an end to the 
unfortunate confusion that may cost some women their very lives.
  Breast cancer is one of the most pressing public health crises facing 
American women today, striking one in every eight women during their 
lifetime. It will strike 180,000 American women this year, and kill 
44,000 women--more than 10,000 of whom will be diagnosed with breast 
cancer in their forties. For women in this age group, it is the leading 
killer, and more women this year will be diagnosed with cancer in their 
forties than in their fifties.
  Mammograms are the most powerful weapon we have in the fight against 
breast cancer. They enable us to detect and treat breast cancer at its 
earliest stages when the tumors are too tiny to be detected by a woman 
or her doctor, providing a better prognosis for treatment. An estimated 
23.5 million mammograms were performed in 1992 at a cost of 
approximately $2.5 billion--a valuable downpayment in our fight against 
an unmerciful killer.
  The question about whether women in their forties should seek regular 
mammograms has been an open question for years. On January 23, an NCI 
consensus panel decided not to recommend that women in their forties 
seek routine mammograms. To justify their position, they argued that 
the costs associated with routine mammograms for women in this age 
group potentially exceed the benefits. In making its decision, the 
panel gave undue weight to hypothetical risks, such as false-negative 
results that potentially provide women with a false sense of security, 
false-positive results that produce unnecessary anxiety, the potential 
for overtreatment, and radiation exposure.
  If we ever hope to improve survival rates for breast cancer, women of 
all ages must receive accurate and consistent information regarding the 
importance of mammograms. Women and their doctors look to the Nation's 
preeminent cancer research institution--the National Cancer Institute--
for clear guidance and advice on this issue.
  Confusion on this issue is not new. In 1989, NCI, along with the 
American Cancer Society and the American Medical Association, issued 
breast cancer screening guidelines which advised women to begin having 
mammograms at age 40. In 1993, NCI rescinded these guidelines, stating 
that their review of clinical trials produced no evidence that 
mammograms significantly reduced breast cancer deaths for women in 
their forties. At the time, Congress and many experts questioned the 
appropriateness of this conclusion, based on the available scientific 
evidence. This is when I first introduced legislation urging NCI to 
reexamine this issue.
  By rescinding its guideline, NCI produced widespread confusion and 
concern among women and physicians regarding the appropriate age at 
which to seek mammograms. This confusion eroded public confidence in 
mammography. It also reinforced the information barrier which 
discourages women from seeking care. Four years later, we are still 
mired in this controversy.
  Yet new studies strongly suggest that routine mammograms for women in 
their forties can save lives. For example, investigators found a 24-
percent lower death rate among women who received mammograms in their 
forties when the world's population-based trials were combined; and 
Swedish researchers in 1996 in two studies found a 44- and 36-percent 
lower death rate among women who received mammograms in their forties. 
And several studies have concluded that breast tumors in women under 50 
grow far more rapidly than breast cancer in older women, suggesting 
that annual mammograms are of value to women in their forties.

  In studying the research and scrutinizing the statistics, the panel 
appears to have lost sight of the human dimension of this question, and 
gave undue weight to the costs of screening, rather than the benefits. 
The panel emphasized that 2,500 women would have to be screened to save 
one life. But this 1 life represents someone's mother, wife, sister, or 
daughter.
  The panel also emphasized that up to one-fourth of all invasive 
breast cancers are not detected by mammography in women in their 
forties. Yet, the flip side of this statistic is that three-fourths of 
all cancers in this age group are detected through mammography. While 
it may not be perfect, that clearly amounts to saved lives.
  Finally, the NCI Panel also overemphasizes the risks of false-
positives, suggesting that many women would undergo unnecessary 
surgical procedures. Yet, most women with positive findings 
subsequently undergo more refined diagnostic tests, including 
diagnostic mammograms, ultrasounds, and needle biopsies to confirm the 
presence of cancer, before any treatment decisions are made.
  Appropriately, the Director of NCI, Dr. Richard Klausner, expressed 
his surprise and disappointment over the decision of the consensus 
panel, and has asked the NCI Advisory Board to convene next month to 
revisit this issue. Former NIH Director, Dr. Bernadine Healy, affirmed 
his views.
  I am asking the Senate to consider my resolution today because women 
and physicians deserve to have guidance on this issue. My resolution 
expresses the sense of the Senate that NCI should conduct studies to 
determine, once and for all, the true benefit of mammograms for women 
in their forties. It also urges NCI's Advisory Board, which will meet 
later this month, to consider reissuing the mammography guidelines it 
rescinded in 1993 which recommended that women in their forties seek 
routine mammograms. Alternatively, NCI should direct women to other 
organizations which have issued clear guidelines on the issue, such as 
the American Cancer Society. This resolution does not dictate science--
it simply helps to provide women with clearer guidance as they look to 
answer a potentially life or death question--should they get mammograms 
in their forties?
  Ms. MIKULSKI. Mr. President, I rise in support of this sense-of-the-
Senate resolution and am pleased to be a cosponsor of the resolution 
with my distinguished colleague, Senator Snowe of Maine. Senator Snowe 
has been an outstanding advocate for many years on the issue of women's 
health. This is yet one more action on her part that shows her deep 
commitment in this area.
  Mr. President, this is a sense-of-the-Senate resolution. I am pleased 
to tell you that my colleagues in the Democratic caucus join with us on 
a bipartisan basis and have endorsed this. All six Democratic women 
have cosponsored this legislation. Over 30 of the men that we call the 
``Galahads'' also cosponsored this resolution.
  What does this resolution call for? It calls for three things that 
would protect women's health, particularly in the area of breast 
cancer. No. 1, it calls for further research on the benefits of 
mammograms for women in their forties; No. 2, it urges the public to 
follow screening guidelines issued by medical groups which call for 
mammography

[[Page S930]]

screenings in women between the ages of 40 and 49; and it calls upon 
the National Cancer Institute to again revisit the guidelines that they 
themselves promulgated, also urging that women who are between the ages 
of 40 and 49 seek mammograms.
  We already have clearly on the record, and clear guidelines have 
established, that women over 50 should get an annual mammogram. It is 
clear that often the older you get, the more likely you are to get 
breast cancer. But there is a particular group of women between ages 40 
and 49 who are particularly prone to breast cancer, and each day we are 
learning more who that category is. Therefore, we are urging through 
this sense-of-the-Senate resolution that traditional guidelines urging 
annual or, at the very least, biannual mammograms for women between the 
ages of 40 and 49 be pursued.
  I could not believe when an NIH advisory panel decided that women in 
this age group might not need mammograms, and at the very best, they 
were either silent or tepid in their recommendations. They made this 
decision because they felt there was not substantial evidence that this 
group was at risk. This flies in the face of what we know through 
studies done at the National Institutes of Health, through extramural 
programs at our great academic centers of excellence, and also in 
worldwide studies of women. The NIH panel should have recognized, also, 
the weight that their announcement carries. This panel absolutely 
confused the public, scared women, and gave permission to insurance 
companies not to pay for a mammogram for a woman between the ages of 40 
and 49.
  Mr. President, we think this creates a public health concern. Now, 
why would we believe that? First, women often have been reluctant to 
seek a mammogram either out of fear or because they do not have the 
Federal resources to do it. We have been working on education to deal 
exactly with those issues and even to offer opportunities for women to 
be able to have funding for this. Also, we have been engaged in an 
impressive and assertive effort to educate primary care physicians in 
urging women to get mammograms.
  We have been dealing with the insurance companies on the whole issue 
of breast cancer. Now some companies have that misguided approach of 
insisting that women leave a hospital in less than 48 hours after they 
have had a mastectomy. Mr. President, we say enough is enough. We 
should take time out, go back to our science, go back to our research, 
go back to the National Institutes of Health and ask them to come up 
with the recommendations that we need. We are urging them to do that. 
Not only are we urging them to do that, but the actual Director of the 
National Cancer Institute, Dr. Richard Klausner, is also recommending 
that this advisory board go back and take another look.
  Senator Snowe has talked about the risk of cancer. We all know that 
any woman can fall prey to breast cancer. It does not matter how old 
she is or what her income bracket is. We know she needs to be screened. 
We know 40,000 women die every year of breast cancer. We know over 
138,000 women every year have some early signs of breast cancer. What 
we are saying on behalf of the women and the men who support us, let us 
go back to our standards.

  I am happy to have joined in this resolution because I know that 
mammograms save lives. And if breast cancer is detected early, the 
probability that a woman will survive is greater than 90 percent. My 
position is simple: Stick to science, go to the guidelines that were 
properly promulgated, listen to doctors and other health care providers 
working in this field.
  Mr. President, for some time we have been working in a bipartisan 
bicameral basis on this. I remember back in the House of 
Representatives when Senator Snowe and I introduced one of the first 
Women's Health Equity Act's that we called for activity in this area. 
We have been working on that ever since, on a bipartisan bicameral 
basis, and not only with the women taking the lead, but with the 
enthusiastic support of the men in our body.
  Thanks to the work of Senators Snowe, Mikulski, and Boxer, and 
Representative Morella and others, we have established the Office of 
Women's Health at NIH. We made more money for research available for 
diseases most affecting women. We ensured that women were included in 
the protocols of medical research, where they had been excluded not 
because of science but because of gender. We worked to expand the 
coverage for mammograms under Medicare and even provided funds for low-
income women to get mammograms. We also have led the fight for 
mammogram quality standards, which we will be reintroducing as it 
expires. We hope to do this together, to show that when it comes to 
fighting for women's health, we are there. We want to make sure that 
each family is able to ensure that breast cancer does not strike them. 
We are going to do it not only on a bipartisan basis, we are going to 
do it on a nonpartisan basis.
  I thank Senator Snowe for taking the lead on this as she has done in 
so many other areas. We are pleased on our side of the aisle to also 
join with her.
  I send to the desk the list of the Democratic cosponsors. I look 
forward to voting for this bill and continuing our advocacy on this 
most crucial issue.
  The PRESIDING OFFICER. Without objection, the sponsors will be added 
to the bill as requested by the Senator from Maryland.
  Ms. SNOWE. How much time remains on this side?
  The PRESIDING OFFICER. The Senator from Maine has 9 minutes and 33 
seconds remaining.
  Ms. SNOWE. I just respond to the Senator from Maryland by commending 
her for her very strong statement, her commitment, and a resoluteness 
to this issue in the hope that women get the best health care in 
America. She has shown strong leadership on this issue throughout the 
years. As she mentioned, we worked on women's health issues beginning 
in the House of Representatives in making some extraordinary changes 
within the National Institutes of Health to create an Office of Women's 
Health, which was absolutely vital because women were excluded--as well 
as minorities, I might add--from clinical studies.
  I thank the Senator and commend her for all she has done on behalf of 
women.
  I yield 3 minutes to the Senator from North Carolina.
  Mr. FAIRCLOTH. Mr. President, I rise in strong support of this 
resolution. For 2 weeks, like many Americans, I was disturbed by the 
news that the National Institutes of Health would not recommend regular 
mammograms for women in their forties.
  Mr. President, we have to call this a deadly and silent disease. The 
fact is, cancer is the leading cause of death for women between the 
ages of 40 to 55. Mr. President, this statistic itself should dictate 
that women in their forties should have regular mammograms. It only 
makes common sense that they should. My worry is that without the 
National Institutes of Health's recommendation, women will be lulled 
into a false sense of security and believing that they do not need a 
mammogram, and that doctors may not always recommend that women in 
their forties have one.
  The last thing we need to say to women juggling family, career, and 
all of the problems they are faced with, is that this can wait. If we 
lead them to believe that, then they will let it wait, and they will 
face dire consequences when they do.
  Too often when these matters are debated, the fact that we are 
talking about the lives of people, the lives of wives, mothers, 
daughters, and friends--by remaining silent on this issue, we are 
putting their health at risk. I thank Senator Snowe for bringing this 
issue to the floor. It is one that deserves national attention and 
certainly the attention of the Senate. I am proud to be an original 
cosponsor of the resolution. I thank Senator Snowe for bringing it to 
the Nation's attention.
  I yield the floor.
  Ms. SNOWE. Mr. President, I now yield 4 minutes to the Senator from 
Texas.
  The PRESIDING OFFICER (Mr. Kempthorne). The Senator from Texas [Mrs. 
Hutchison] is recognized for 4 minutes.
  Mrs. HUTCHISON. Thank you, Mr. President. I thank Senator Snowe and 
Senator Mikulski. All of the women in the Senate are cosponsoring this 
resolution. I will never forget 2 years ago

[[Page S931]]

when Senator Mikulski called a hearing of all of the women in the 
Senate on the first time we saw there was a question by the National 
Institutes of Health about whether women should have screening before 
the age of 50. All of us, resoundingly, came together and said, ``Of 
course they should.'' Now we have new Members in the Senate--Senator 
Snowe, Senator Collins, Senator Landrieu, who have joined us in a 
unanimous verdict, which is that the women of this country deserve 
better.
  The women of this country deserve to know the facts. The facts are 
that the studies have come in. In 1995, a study showed a 24-percent 
lower death rate among women who received mammograms in their forties. 
That was an American study. In 1996, Swedish researchers, in two 
studies, found a 44-percent and a 36-percent lower death rate among 
women who received mammograms in their forties.
  So why are we getting a mixed message? Why aren't all of the experts 
coming together on an issue that is killing more women in their forties 
than any other disease? The women of America have no guidelines. They 
have no guidelines because we can't get our doctors to do what they do 
for every other medicine and every other disease that I can think of, 
and that is to say we can have a 24-percent lower death rate of the 
women in this country in the 40-to-49 age bracket if we will have 
mammograms. But there is a slight chance, perhaps less than 1 percent, 
that having a mammogram might induce cancer.
  Now, I think we are intelligent enough to receive the full facts and 
not have a mixed message. That is not a mixed message. When we can save 
thousands of lives by having mammograms between the ages 40 and 49, and 
there is a, perhaps, less than 1 percent chance that it might be a 
danger, let's give women the facts without a muddled message. That is 
what this resolution does today. It says to the women of our country, 
very clearly, that their chances of surviving breast cancer are 
infinitely better, and all the studies show it, if they will have a 
mammogram, starting at the age of 35 or 40, every 2 years, and then 
when you are 50, every year. It is very simple. The women of this 
country deserve to know that their chances are a heck of a lot better 
if they will have this procedure done.
  Now, something that you all have not mentioned yet, which I worry 
about very much, is that now that we have this mixed, garbled message, 
are insurance companies going to step forward and say, now, wait a 
minute, maybe we should not cover mammograms? Is this going to open the 
door to questions as to whether this very basic preventive procedure 
will be available to the women of this country?
  We must speak with a certain voice today in saying to all of our 
health institutes: Come forward and give us leadership. You are the 
experts. I think we can take the facts, and I think we can save the 
lives of thousands of women if we will say exactly what all of the 
statistics show, which is to take care of yourself. Have a mammogram, 
starting at the age of 35 or 40, every 2 years, and then, at 50, every 
year. Let's not even introduce the option of insurance perhaps not 
covering this kind of preventive procedure that is killing more women 
between the ages of 40 and 49 than any other disease in this country.

  So I commend all of my women colleagues and friends for coming 
together, along with all of the men cosponsoring this amendment and ask 
for a unanimous vote today at 5 o'clock supporting this, urging experts 
to help the women of our country protect themselves.
  Ms. MIKULSKI. Mr. President, how much time is left on our side?
  The PRESIDING OFFICER. The Senator from Maryland has 6 minutes 44 
seconds. The Senator from Maine has 1 minute 40 seconds.
  Ms. MIKULSKI. I reserve my time. Senator Specter has 10 minutes on 
his own time. I have no objection to his proceeding.
  Mr. SPECTER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Mr. SPECTER. Mr. President, I support the pending resolution because 
it focuses attention on the need for mammograms that would give the 
imprimatur of the U.S. Senate to this important medical testing device. 
I, with many other Americans, was very surprised when, on January 23, a 
report was issued questioning the advisability of mammograms with the 
essential finding that there was not enough evidence that women in 
their forties would benefit by advising them to have the x-ray test as 
part of routine health screening. The question which then came to my 
mind was whether there was enough evidence to conclude that women in 
their forties would not benefit from the mammograms as part of routine 
health screening.
  To articulate the conclusion in the form that there was not 
sufficient evidence to show that women would benefit is really not to 
answer the question, because where the evidence may be in doubt in the 
minds of some scientists, the practical sense conclusion is that there 
is very, very substantial evidence to show that mammograms are helpful 
and that underlying a decision not to have mammography is a question 
about cost-benefit ratio and a question about certain collateral 
issues, which need not necessarily be faced, as to whether there will 
be unnecessary biopsies.
  This matter struck home with me especially, because in 1993, when I 
sought an MRI examination of my head, I was told by the doctors that I 
did not need it. I then insisted on having it, and they found a 
potentially life-threatening problem, which was corrected after I got 
the MRI. There is an attitude in many quarters that unless the burden 
of proof rises to a certain level, and perhaps a very high level, these 
tests ought not to be given. I think that is the wrong standard of 
evaluation.
  Mammograms are expensive; MRI's are expensive. But I am convinced, 
from the work I have done as chairman of the Appropriations 
Subcommittee on Health and Human Services, that we have enough 
mammography equipment and enough specialists and enough administrators 
and enough MRI machines, et cetera, to conduct the necessary tests. It 
may be necessary to do them in the evening. If an MRI costs $800 at a 
convenient time during the day, maybe it could be accomplished at 2 
a.m. or 3 a.m. for $50, with a margin of cost as to what it would take.

  When this report came down on January 23, 12 days ago, I immediately 
scheduled a hearing of the Appropriations Subcommittee on Health and 
Human Services. Tomorrow we will be hearing from the people who came to 
the conclusion that mammograms are not warranted for women in their 
forties, and we will also be hearing from people who have reached the 
opposite conclusion.
  I think it is very significant that Dr. Richard D. Klausner, Director 
of the National Cancer Institute, expressed shock when he heard of this 
report that mammograms were not warranted for women in their forties.
  Dr. Bernadine Healy, former Director of NIH, made this succinct 
statement: ``What are they saying--that ignorance is bliss?''
  Dr. Daniel B. Kopans of the Harvard Medical School said the 
committee's report was ``fraudulent,'' which was the way he termed it.
  And if you take a look at this issue historically, in 1977, the 
National Cancer Institute and the American Cancer Society recommended 
that women 40 to 49 have mammograms only if their mothers or sisters 
had breast cancer. In 1980, the Cancer Society recommended that one-
time mammograms for women 35 to 40 were warranted to establish a 
baseline for future measurements for women under 50. In 1983, the 
Cancer Society recommended that symptom-free women 40 to 49 have 
mammograms every 1 or 2 years.
  In 1987, the Cancer Institute adopted a working guideline to begin 
screening women age 40 with mammograms every 1 to 2 years. In 1989, 
those guidelines were officially adopted by a conference of leading 
cancer organizations.
  Then, in 1993, the National Cancer Institute changed the 
recommendation, saying ``Experts do not agree on the value of routine 
screening of mammography of women ages 40 to 49.'' They do not agree 
that women in that age category ought not to have mammograms. And I say 
on the face of this record with succinct evidence that women do benefit 
from mammograms. Even though there is conflicting evidence, we ought to 
err on the side of safety,

[[Page S932]]

and mammograms ought to be available.
  But when there is a national report questioning the value for women 
40 to 49, immediately it is going to send shock waves to the women of 
America who will say, ``Well, maybe I do not really need a mammogram.''
  It is very difficult to get some people to take medical tests because 
people very understandably, very naturally, are afraid of the results. 
If you have this conclusion from a group of experts that you really 
ought not to have it, that it is not a matter of necessity, then women 
are not going to take it. Where you have this kind of report too, those 
who are responsible for paying for mammograms are going to have a good 
reason to say, ``We are not going to cover mammograms for women in the 
40 to 49 category.''
  When we have the hearing in the Appropriations Subcommittee on Health 
and Human Services tomorrow it will be a rather unusual hearing as far 
as I am concerned. Most of the time we have these hearings to answer 
questions. This is one hearing that I am approaching with the fixed 
opinion from all that I have studied in the past to really find a 
direction so that the National Cancer Institute will take whatever 
steps are necessary to resolve this issue in favor of having 
mammograms. It is simply not sufficient to say on the evidence that 
when there is conflicting evidence we are going to reject mammograms 
for women in the 40 to 49 age category.
  In addition, I think that the National Cancer Institute ought to be 
doing more on multiinstitutional testing of MRI's on imaging. Last 
year, with the help of the Central Intelligence Agency and a special 
contribution made with the help of then-Director John Deutch, some $2 
million was put up by the CIA for imaging processes on the proposition 
that if the CIA could image and detect through clouds and look to the 
Earth to find out what was going on that those processes could be 
helpful in the detection of breast cancer.

  So I compliment my distinguished colleague from Maine and my 
distinguished colleague from Maryland for their leadership.
  I would like to add that for the National Institutes of Health 
budget, specific research funding for women was added that Senator 
Harkin, then-chairman of the Appropriations Subcommittee on Health and 
Human Services, and I as ranking member, supported. I must say that I 
like it better to be chairman and have Senator Harkin as ranking 
member. But there has been very considerable attention to this issue 
not only by our very distinguished women Senators but many on the male 
side as well.
  I hope that the vote this afternoon--and I am confident that it will 
be, knowing our colleagues on issues of this sort--will be a resounding 
vote to send a message to the women of America that they ought to get 
mammograms, that they ought to protect their health, and that where it 
is an open question as to whether it is cost-effective, let us err on 
the side of taking the test.
  I say that with some substantial experience in the field of having 
undergone a test that the experts said I didn't need, which for me was 
a life-saving procedure.
  I thank the Chair, and I yield the floor.
  Mr. MURKOWSKI. Mr. President, I rise as a cosponsor of this important 
resolution which expresses the sense of the Senate that further 
research is necessary to determine the benefits of mammography in women 
ages 40 to 49.
  Mr. President, I have been very involved with mammography issues in 
Alaska and have worked with my wife Nancy to promote access to this 
important diagnostic tool. I would like to bring to the Senate's 
attention the work my wife Nancy, and others, has promoted on behalf of 
the Breast Cancer Detection Center of Alaska.
  The Breast Cancer Detection Center of Alaska had its beginnings in 
1974 when seven Fairbanks women decided that health care for women, 
especially in the area of breast cancer, should be made more accessible 
and less expensive for residents who live in remote areas of Alaska. In 
1976, with very humble beginnings, the center opened its doors in 
Fairbanks, staffed and equipped by volunteers. The State granted the 
moneys for a GE mammography machine and a local bank loaned the 
basement of a drive-in branch for the clinic offices. Furniture, 
carpeting, and paint was donated by local merchants, and a nurse-
administrator, radiologist, and two doctors volunteered their services. 
Breast examination was taught and recommended mammograms were provided 
free of charge.
  Today, the center, housed in a very spacious office, is staffed by an 
executive director, two office personnel, a certified mammographer, and 
a radiologist. The lo-rad mammography machine is one of the finest in 
the State. The center still maintains the policy of waiving a fee for 
women who cannot afford to pay or do not have insurance.
  With the unwavering support of the Fairbank community the center has 
been operating for 20 years with donations, insurance, and fundraisers 
by local service organizations.
  Three years ago, the executive director informed the board of 
directors that a new mammography machine was needed to keep up with 
advancing technology. Nancy and I offered to do a fundraising fishing 
event in southeastern Alaska to benefit the center. At that first 
event, Waterfall '94, over $140,000 was raised for the breast cancer 
center and completely offset the cost of the new state-of-the-art lo-
rad mammography unit.
  Because of the overwhelming success of Waterfall '94, we decided to 
hold a similar event the following year to again benefit the center. 
Nancy, one of the original founders of the center, had long desired to 
have a mobile mammogram van to serve the Yukon River system villages, 
and the rural bush communities of Alaska. Waterfall '95 made that dream 
come true with a donation of $210,000 to the center. Waterfall '96 will 
benefit the center with an approximate $240,000 donation. Plans are 
already in place for the Waterfall '97 event with plans to incorporate 
prostate PSA tests, and to do cervical cancer checks as well.
  The Breast Cancer Detection Center of Alaska now visits remote bush 
villages along the river system and the highways with a 43-foot van 
equipped with a mammogram unit and darkroom with a film processor, two 
dressing rooms which double as bunks for the driver and mammography 
technician, a small reception area, and a bathroom which can 
accommodate wheelchairs. There is a hydraulic lift for wheelchair entry 
into the van as well.
  While most American women face a 1-in-9 risk of dying of breast 
cancer, Alaskan women face a 1-in-7 chance. Among Alaska Native women, 
cancer is the leading cause of death and breast cancer is the second 
most prevalent cancer. Now there is no reason for these women not to 
learn about early detection. Julia Roberts, from the small village of 
Tanana, said it all when she came to the van for her exam. ``I know 
it's important. I know if you catch it early you can probably save your 
life. I have three children and I want to see my grandchildren.''
  Mr. President, we need more fundamental research on breast cancer. 
And I strongly support further study to determine the adequacy and 
effectiveness of mammography for women in the 40-to-49-age bracket.
  Mrs. BOXER. Mr. President, I rise as an original cosponsor of this 
resolution concerning the need for accurate guidelines for mammography 
screening for women between the ages of 40 and 49.
  Since 1993, when the NCI rescinded its original guidelines I have 
been trying to get them to return to their original position. In the 
past 3 years, I have written several letters to the heads of the 
National Cancer Institute [NCI], asking that it reconsider its position 
on mammography screening for women between the ages of 40 and 49.
  We have seen study after study that shows that mammography screening 
at an earlier age can help save women's lives. Women and physicians 
have come to depend on the recommendations of the NCI in determining 
when they should begin mammography screening.
  NCI's decision to back away from screening for women between the ages 
of 40 and 49 has led to confusion and anxiety. I applaud Dr. Klausner, 
head of the NCI, for convening the advisory panel. But like him, I am 
disappointed that the panel issued no concrete guidelines to aid women 
and their doctors.

[[Page S933]]

  Since we cannot prevent or cure breast cancer, mammography screening 
remains the best tool we have to detect it early when chances for 
survival are highest. We cannot now eliminate the only hope younger 
women have for fighting this dreaded disease.
  This resolution is an important step in the right direction. The NCI 
needs to recognize the importance of mammograms for women in their 
forties and reissue its previous guidelines.
  I ask unanimous consent that the three letters I referenced in my 
statement be printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                                      U.S. Senate,


                                  Hart Senate Office Building,

                                Washington, DC, November 30, 1994.
     Samuel Broder, M.D.,
     Director, National Cancer Institute, National Institutes of 
         Health Buildings, Bethesda, MD.
       Dear Dr. Broder: I have previously expressed to you my deep 
     concerns about the National Cancer Institute's position on 
     mammography screening for women between the ages of 40 and 
     49. I am writing today because I believe that studies 
     released this week underscore the need for prompt 
     reconsideration of the position taken by the NCI.
       As you probably know, two studies presented at the annual 
     conference of the Radiological Society of North America 
     concluded that mammography is of substantial benefit to women 
     between 40 and 49. In a study done by the Screening 
     Mammography Program of British Columbia, 15 percent of the 
     cancers detected through mammography were in women under 50. 
     Eighty-seven percent of the tumors discovered were at an 
     early, curable stage.
       Annual mammograms for women 40 and over also resulted in 
     the greatest chance of recovery and the largest number of 
     treatment options, in an analysis of 851 breast cancer 
     patients at the Thomas Jefferson University Hospital in 
     Philadelphia. The authors of this study concluded that 
     mammography was particularly important for women under 50 due 
     to the speed with which tumors develop in younger women.
       With this new research strongly suggesting great benefit in 
     mammography screening for women between 40 and 49, I ask the 
     NCI once again to reconsider its position and return to its 
     original guidelines.
       Please contact me as soon as possible as I need to 
     determine what further action I will take on this matter.
           Sincerely,
                                                    Barbara Boxer,
     U.S. Senator.
                                                                    ____

                                                      U.S. Senate,


                                  Hart Senate Office Building,

                                Washington, DC, December 23, 1994.
     Dr. Samuel Broder,
     Director, National Cancer Institute, National Institutes of 
         Health Building, Bethesda, MD.
       Dear Dr. Broder: Three weeks ago I wrote to you about the 
     National Cancer Institute's (NCI) position on mammography 
     screening for women between the ages of 40 and 49. I continue 
     to believe that this issue merits your immediate attention.
       As I have stated previously, women and physicians have come 
     to depend on the recommendations of the NCI in determining 
     when they should begin mammography screening. NCI's decision 
     to back away from screening for women between the ages of 40 
     and 49 has led to confusion and anxiety.
       NCI's position on this issue is especially distressing in 
     light of the conclusions found in a recent report prepared by 
     the House Government Operations Committee titled ``Misused 
     Science: The National Cancer Institute's Elimination of 
     Mammography Guidelines for Women in Their Forties.''
       This report notes that several senior scientists at NCI 
     questioned the scope and quality of studies used by NCI to 
     reverse its position on mammography and that NCI ignored the 
     14 to 1 decision by its own National Cancer Advisory Board 
     ``to defer'' action on any changes to the mammography 
     guidelines. The latter point was one which I had brought to 
     your attention in July.
       Two new research studies presented at the annual conference 
     of the Radiological Society of North America last month now 
     strongly support mammography screening for women under age 
     50. I outlined these studies and their findings in my letter 
     to you of November 30.
       It is time for the NCI to reconsider its position on 
     mammography screening for younger women. I would like to meet 
     with you personally to discuss what actions the NCI can take 
     on this matter. Please contact me as soon as possible to 
     arrange for an appointment.
           Sincerely,
                                                    Barbara Boxer,
     U.S. Senator.
                                                                    ____

                                                      U.S. Senate,


                                  Hart Senate Office Building,

                                 Washington, DC, December 3, 1996.
     Dr. Richard Klausner,
     Director, National Cancer Institute, National Institutes of 
         Health Building, Bethesda, MD.
       Dear Dr. Klausner: Over the past two years, I have written 
     several letters to both you and your predecessor, Dr. Samuel 
     Broder, asking that the National Cancer Institute (NCI) 
     reconsider its position on mammography screening for women 
     between the ages of 40 and 49.
       As I have stated previously, women and physicians have come 
     to depend on the recommendations of the NCI in determining 
     when they should begin mammography screening. NCI's decision 
     to back away from screening for women between the ages of 40 
     and 49 has led to confusion and anxiety.
       As you know, yesterday at the Radiological Society of North 
     America meeting in Chicago, new research was presented which 
     supports the position that mammography screening for women 
     should begin at age 40.
       I understand that next month the NCI will convene a panel 
     of experts to reconsider this issue. Given the new research 
     which convincingly supports mammography screening for women 
     between the ages of 40-49 when the panel convenes next month, 
     I urge you to reconsider your position and reinstitute the 
     original guidelines on mammography screening.
       Since we cannot prevent or cure breast cancer, mammography 
     screening remains the best tool we have to detect it early 
     when chances for survival are highest. We cannot now 
     eliminate the only hope younger women have for fighting this 
     dreaded disease.
           Sincerely,
                                                    Barbara Boxer,
                                                     U.S. Senator.

  Mr. KENNEDY. Mr. President, I support this sense-of-the-Senate 
resolution which calls for the National Cancer Institute to reissue 
guidelines for breast cancer screening for women between the ages of 40 
and 50. Although an NIH advisory panel decided that women in their 
forties may not need mammograms, this finding continues to be a 
controversial one. Even though some studies have shown that mammography 
may not always be effective in detecting breast cancer, we can't ignore 
the importance of the early detection of this disease. Early detection 
and treatment will lead to reductions in breast cancer mortality. 
Failure to encourage breast cancer screening for women in their forties 
may well have disastrous results.
  The scientific literature is controversial. In this situation, it 
makes no sense to rescind the current mammography guidelines and 
standards. The evidence is far from conclusive that screening brings no 
positive effect for women in their forties. Further studies need to be 
conducted before our choice is made. We need to do all we can to 
encourage the early detection of breast cancer. I commend Senator Snowe 
and Senator Mikulski for their leadership, and I urge the Senate to 
pass this important resolution.
  Mr. MACK. Mr. President, in 1993, the National Cancer Institute 
rescinded its recommendation that all women in their forties undergo 
mammography screening for breast cancer. Since then, American women 
have been receiving mixed messages about the importance of mammography.
  Women are confused. Women are angry. Women are frightened. Given the 
wide variety of recommendations being made about mammography screening 
for younger women, one can certainly understand why.
  The scientific community is deeply divided on the interpretation of 
data from mammography clinical trials conducted in the United States 
and elsewhere. Cancer advocacy organizations are split on the proper 
recommendations to give their members and the public. Physicians want 
to provide the best recommendations to their patients, but there is no 
single answer to give them. Insurance companies frequently deny 
coverage of benefits unless there is compelling scientific data to 
warrant coverage.
  Clearly, women want to be more involved in making health care 
decisions for themselves. But when the medical, scientific, and patient 
advocacy communities cannot agree on the issue of mammography 
screening, women are being placed in a situation where they must make, 
at best, an educated guess as to what they should do to protect 
themselves from a disease which will kill an estimated 44,000 women 
this year.
  Women and their families were hopeful they would get clear answers 
when the National Institutes of Health convened the Consensus 
Development Conference on Breast Cancer Screening for Women Ages 40-49.
  Unfortunately, the Consensus Development Conference statement 
contains more mixed messages, more confusing data and few real answers.
  The report concludes, ``zero to 10 women would have their lives 
extended

[[Page S934]]

per 10,000 women ages 40-49 who are regularly screened. About 2,500 
women should be screened regularly in order to extend one life.'' These 
two statements leave a great deal of room for interpretation by women, 
their physicians and their families.
  The report concludes, ``up to 25 percent of all breast cancer is not 
detected by mammogram in women ages 40-49.'' One could therefore 
logically conclude that 75 percent of all breast cancer is detected by 
mammography performed on women in this age group. To me, the fact that 
75 percent of breast cancers will be detected through mammography is 
very significant. In addition, this conclusion also makes a compelling 
case for additional research to develop more sophisticated equipment 
which can detect breast cancer earlier than today's mammography 
technology can.
  The report also concludes that use of mammography has contributed to 
a growing trend that breast cancer tumors are being detected when they 
are small, and at an early stage. The report states that, ``the 
presence of smaller or earlier stage breast tumors can give a patient 
more choice in selecting among various treatment options.'' Research 
has shown that lumpectomy, combined with radiation therapy, is as 
effective as mastectomy when the tumor is detected early.
  One area all parties involved in this issue can agree upon is the 
need for additional research. I have introduced Senate Resolution 15, 
to express the sense of the Senate that funding for biomedical research 
activities of the National Institutes of Health should be doubled over 
the next 5 fiscal years. It is only through research that definitive 
answers to these very important research questions can be obtained.
  While I respect the conclusions of the consensus panel, I believe the 
message being sent to younger women throughout America is wrong. They 
are being told, in essence, that early detection of breast cancer may 
not be all that important. I believe most women reject that conclusion.
  On numerous occasions, I have spoken about how my own family has been 
affected by cancer. My wife and my mother are both survivors of breast 
cancer because it was detected at an early stage. It haunts me to think 
what might have happened if they had received the message that women 
are currently receiving with this report.
  I support this sense-of-the-Senate resolution. I believe it is 
important that the Senate send the message that more research is needed 
to further determine the benefits of mammography screening in younger 
women, that the National Cancer Institute should reconsider its 
mammography screening guidelines, and to encourage the public to 
consider cancer screening guidelines issued by other organizations.
  Ms. MIKULSKI addressed the Chair.
  The PRESIDING OFFICER. The Senator from Maryland is recognized.
  Ms. MIKULSKI. Mr. President, I want to conclude the debate on this 
side by reaffirming that this resolution does not meddle with the 
National Institutes of Health. It does not meddle with science. It 
essentially says let us have more research on the subject of breast 
cancer in terms of its cause, in terms of its prevention, and in terms 
of its cures.
  It also calls for the women of America and their physicians to follow 
those guidelines that are recommended by every physician group as well 
as the American Cancer Society on urging women in the age 40 to 49 
group to have either an annual or biannual mammogram.
  Third, it asks the National Cancer Institute to repromulgate its own 
guidelines urging the same.
  I would like to comment that this advisory panel that made this 
report in January is not made up of NIH scientists. This is an outside 
advisory group to the National Institutes of Health.
  Mr. President, I have the honor of representing the National 
Institutes of Health because it is in my State. How wonderful to be 
able to represent a Government organization devoted to saving lives by 
finding cures and causes for the diseases that threaten Americans and 
others around the world.
  The National Cancer Institute has taken specific steps to be far more 
sensitive and to have a budget priority looking at those gender-
specific diseases, particularly breast cancer and ovarian cancer. And 
we are pleased also with the work that is now being done in the area of 
prostate cancer as well.
  I believe that the National Cancer Institute is on the right track. 
We want to be sure that they continue their scientific research, and if 
there is a gray area about when you should have a mammogram always go 
to the side of safety. Always go to the side of caution. One of the 
things we know is that when you are treated by a physician more 
information is often better information.
  So, Mr. President, I urge unanimous adoption of this sense-of-the-
Senate resolution.
  Knowing no other Democrats who wish to comment on this issue, I yield 
the remainder of my time and look forward to the vote at 5 p.m.
  Ms. SNOWE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. SNOWE. Mr. President, in conclusion I would like to make several 
final points.
  First of all, I would like to commend Senator Specter for his 
commitment and devotion for years on this issue, and in particular 
tomorrow for holding a hearing as the chairman of the Labor-HHS 
Committee on Appropriations which I think will be very significant in 
highlighting and profiling the importance of this issue.
  Finally, I also would like to say that I think it is critical that he 
send a very strong message to the Cancer Institute advisory panel that 
will be meeting later this month to revisit this issue, and, if they 
see that we have a very strong vote here in the U.S. Senate from all 
Senators across the political aisle, clearly I think they will rescind 
the statement that they made last month in not making any 
recommendation for women in their forties. I think it is an abdication 
of their responsibility, and an abdication of their knowledge of 
medical science in terms of what is best for women.
  I am very pleased as well that all nine women here in the U.S. 
Senate--all Republican and all Democratic women--are cosponsors of this 
resolution.
  I do hope that we can get unanimous support of this issue so that we 
can correct what I think has been a wrong decision on the behalf of 
women in America and does nothing to advance women's health.
  That is why this resolution becomes a critically important statement 
to the lives, health, and safety of women in America.
  I yield the remainder of my time.
  Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. Under the previous order, the vote on this 
resolution will occur at the hour of 5 p.m.
  In my capacity as a Senator from the State of Idaho, I suggest the 
absence of a quorum. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BUMPERS. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Gorton). Without objection, it is so 
ordered.

                          ____________________