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Mammograms still the best way to detect breast cancer, despite falling rates

SPRINGFIELD "Think you're too busy? What's your excuse for not getting your annual mammogram?" Dr. Grace Makari-Judson, medical director of the Comprehensive Breast Center, part of the Baystate Regional Cancer Program, asked.

Know the facts during Breast Cancer Awareness Month in October mammography reduces the risk of dying from breast cancer by 63 percent. Despite the well-established benefits, records from the Mass. Department of Public Health show we are falling below the goals set for screening, noted Dr. Makari-Judson.

In 1987 there was a rapid increase in the number of women undergoing screening mammography as education and advocacy programs were on the rise. Now, for the first time in 20 years, there is a drop in rates of mammography on a national and local level. In 2005, only 66 percent of eligible women had their screening mammogram, compared with 70 percent of women in 2000.

"Although this may seem like a small change, it is cause for concern," said Makari-Judson, who also serves as associate professor of medicine, Tufts University School of Medicine.

Breast cancer is the most common form of cancer in women in the United States with one out of eight women developing the disease in her lifetime. For 2008, it is estimated that 182,460 new cases will be diagnosed and 40,480 women will die from the disease.

"The number of new cases is down over the past five years and some optimistically attribute this to the sharp decline in women using postmenopausal estrogen. Others take a more pessimistic view and worry that we are seeing fewer early cases due to a drop in mammography rates that will only surface in the coming years as more advanced cancer," said Makari-Judson.

She said especially concerning is it appears to be women ages 50 to 64 who are the least compliant with screening the same outspoken baby boomers who were advocates of breast cancer awareness a decade ago.

What are barriers? They include fear, cultural beliefs and language, lack of knowledge and access to screening services. Rays of Hope has partnered with the Comprehensive Breast Center and the American Cancer Society to increase outreach programs to address these barriers.

Even women with adequate health insurance are falling below the mark. Insurers set higher benchmarks aiming to have 60 to 80 percent of covered participants screened and are looking at ways to improve compliance. Some of these strategies include reminder systems and more convenient bookings. Some employees can take time off from work for cancer screening, but no widespread policies exist to allow this. So, although it's not clear why women aren't complying at higher rates, what is clear is that mammography saves lives, noted Makari-Judson.

Three recent studies analyzed differences in breast cancers diagnosed by mammography alone compared to breast cancer diagnosed by other methods, such as a palpable lump.

These studies found that women with breast cancers detected by mammography alone had a better prognosis even when lined up by size and lymph node status.

The American Cancer Society recommends yearly clinical breast exam by a physician starting at age 30 and yearly screening mammography starting at age 40. Mammography and physical examination are complementary and the use of both offers the best strategy for screening. High-quality mammography includes the use of dedicated state-of-art mammographic equipment, technologists who are specially trained in mammography, and radiologists with expertise in breast imaging. Benefits of monthly breast self exam have been more controversial, however, breast self exam enhances a woman's knowledge of her own body, is inexpensive and noninvasive, noted Makari-Judson

When compared to 10 years ago, Makari-Judson said the cancers being diagnosed today are more often early stage, require less extensive treatment and have an excellent outlook.

"This is partly due to improved cancer treatments but also to the routine use of screening mammography. And because 70 percent of those diagnosed with breast cancer may have no risk factor other than being female, and perhaps their age, screening is important for all women," she said.

Baystate Medical Center's Comprehensive Breast Center provides specialized services for women who need routine screening, high risk women and women with breast cancer. Services include routine and diagnostic digital mammography, ultrasound and core biopsy, breast MRI, and diagnostic evaluations. For women with a family history of breast cancer, risk assessment and genetic consultations are available. For women with breast cancer, breast surgeons, radiation oncologists and medical oncologists work together to assure the coordinated, multidisciplinary care.

The Comprehensive Breast Center also provides a number of support services, education programs and outreach in the Springfield area, Franklin Medical Center in Greenfield, and Mary Lane Hospital in Ware.

To make an appointment with a breast specialist, call the Baystate Regional Cancer Program/Comprehensive Breast Center at 794-9338 or to schedule a mammogram call 794-2222.