Institute Recommends Mammograms After 40 Decision Intended To End Debate Over Breast Cancer Screening

The National Cancer Institute reversed itself Thursday and recommended that women in their 40s undergo routine mammogram screening, a decision it hopes will lay to rest one of the most fractious national debates in recent medical history.

The institute, part of the federal government’s National Institutes of Health, said women of average risk should be screened every one to two years beginning at age 40, while women whose risk is higher - such as those with a family history of the disease or a genetic predisposition for it - should consider having mammograms even earlier.

President Clinton, whose mother died of breast cancer, said the recommendations “give clear, concise guidance to women in our national fight against breast cancer.” He announced a series of steps aimed at making mammograms more readily available to the targeted age group.

The institute’s announcement followed a Sunday announcement by the American Cancer Society urging women in their 40s to have the procedure done annually, a change from its previous recommendation of every one to two years. The institute and the cancer society - regarded as the nation’s two most influential cancer policy-making groups - issued a joint statement Thursday saying their advice should be regarded as compatible.

The institute had been under strong pressure from members of Congress, the medical community and patient advocacy groups to rescind a 1993 recommendation that women 40 to 49 years old need not undergo annual mammogram screening. At the time, it cited studies showing no difference in breast cancer death rates among women who began screening at age 50 and those started earlier. But recent studies have shown a reduction in deaths from breast cancer among women in their 40s who had regular mammograms.

On Thursday, Dr. Richard Klausner, the institute’s director, “There is no doubt that screening mammograms are capable of saving lives. The question that has been difficult to resolve is when women should begin. … We hope these new recommendations will clarify what has been a confusing issue for women in their 40s.”

Clinton said the federal government would launch a national breast cancer education program to get the latest information to the public and to health care workers. He also said his administration would assure state directors of Medicaid - the health program for the poor - that federal money is available to help pay for mammograms for women in their 40s.

He promised to require federal employee health insurance plans to cover the procedure for this age group, and he challenged private-sector plans to do the same. Some private plans do, but it varies depending on states and policies.

Mammograms generally cost between $40 and $150.