[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mammography guideline it rescinded in 1993 recommending that women in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.
____________________