The New York Times, December 28, 1993, p. A12
To the Editor:
The debate on mammography reflects flawed science and misplaced emotionalism (front page, Dec. 27). Despite more than three decades of large-scale experience in the United States and elsewhere, no study has shown any benefit for mammography in premenopausal, as opposed to postmenopausal women.
But substantial documentation on radiation risks to the breast has accumulated since the late 1980's. This includes evidence that mammography, especially in younger women whose breasts are sensitive to radiation, is likely to cause more cancer than could be detected. These risks are greater in women who unknowingly carry the A-T gene, which substantially increases risks from radiation cancer.
There is also evidence that radiation can synergize the carcinogenic effects of estrogens from sources such as oral contraceptives.
As an editorial in The Lancet, the British medical journal, emphasizes, recent studies have shown excess breast cancer mortality in premenopausal women receiving repeated mammography. Rather than pressuring the Clinton Administration for ineffective and hazardous mammography in younger women, the American Cancer Society and its supporters would do well to encourage a program to develop and use safer alternatives, such as transillumination with infrared light scanning and magnetic resonance imaging, besides emphasis on training in regular breast self-examination. Meanwhile, there is no reason to extend insurance coverage for premenopausal mammography.
Samuel S. Epstein, M.D.
Professor of Environmental and Occupational Medicine
U. of Illinois
School of Public Health
Chicago, December 28, 1993