Three months ago, NCI abandoned guidelines on breast cancer screening. Now, the National Cancer Advisory Board wants NCI to abandon the idea of offering guidelines altogether.

In a resolution adopted last week, the board stated:

“Inasmuch as cancer research is the primary mission of the National Cancer Institute, the NCAB recommends that the NCI not involve itself independently in the setting of health care policy.”

The impetus for the resolution was last year’s controversy over the 1988 consensus guidelines on breast cancer screening. When NCI drafted new guidelines that proved as controversial as the 1988 version, the NCAB asked the Institute to keep the older version in place until better data became available (The Cancer Letter, Nov. 26, 1993).

NCI did not follow that advice, but abandoned the attempt to write new breast cancer screening guidelines. Instead, the Institute offered a “summary of scientific fact” discussing the lack of consensus regarding mammography screening of women under age 50 (The Cancer Letter, Dec. 10, 1993).

Last week’s resolution recognizes that NCI does not have the authority to dictate treatment and screening decisions to doctors and the public, said Sydney Salmon, director of the Arizona Cancer Center and the resolution’s sponsor.

“The FDA can speak for the government on drugs, but NCI cannot speak for the government on health policy,” Salmon said.

NCl’s Role To Generate Information

Agreeing with the NCAB, NCI Director Samuel Broder said the Institute is not seeking a health policy role.

“We need to protect our core function, which is to generate knowledge about cancer,” Broder said. “In one era, we were under a strong mission of both the generation of knowledge and its implementation. In an era of health care reform, setting guidelines is not a function NCI should play.”

In the late 1980s, NCI went along with the consensus guidelines developed by the American Cancer Society and other organizations “pending the results of clinical trials,” Broder said. This put NCI in an uncomfortable position when the trial results were not definitive, he said.

“Where the Institute has a lot of difficulty is when we make a promise,” Broder said. “Then we’re talking pure policy and not science.”

NCI should avoid this kind of”promissory notes,” stick to the facts, and leave socioeconomic issues and health policy to other government agencies, including the Dept. of Health & Human Services US Preventative Health Services Task Force and the Agency for Health Care Policy and Research, Broder said.

Not Equipped To Move Beyond Fact

The board passed the resolution on a vote of 14-0, with one abstention, that of Zora Brown, a breast cancer patient advocate.

Last November, Salmon offered a similar resolution but withdrew it because the board appeared to oppose it.

Over the past few months, NCI officials and advisors have said that the Institute is not equipped for issuing recommendations that go beyond scientific fact.

Helene Brown, of the Jonsson Comprehensive Cancer Center, UCLA, and a member of the Div. of Cancer Prevention & Control Board of Scientific Counselors, was the first NCI advisor to publicly suggest that the Institute get out of “the guidelines business” (The Cancer Letter, Oct. 29, 1993).

“NCI does not have a process to issue guidelines,” NCAB member Erwin Bettinghaus said to the board last week. “There was no process in 1987 and there is no process now.”

The Institute’s abstention from making guidelines does not mean that public groups should do likewise, Broder said.

“I am very comfortable with organizations like the American Cancer Society making recommendations from their point of view,” Broder said. “Many issues that prompted us to write guidelines [in the past] will be solved by health care reform, in one way or another.”

Harold Freeman, chairman of the President’s Cancer Panel, said NCI should be able to advise the public to eat more fruit and vegetables, or not to smoke. That advice is included in HHS health recommendations, said DCPC Director Peter Greenwald.

NCAB member Charles Wilson cited the PSA screening test for prostate cancer as an example. “We can say it has value and has a place, but health policy research can define better the population for which it is most useful,” he said.