by Joseph Rosen, MD
The American Cancer Society, (ACS, 2009), estimates that 15% of all U.S. cancer deaths this year, in women, will be from breast cancer. This is after a decade long decline in the risk of a women dying after a breast cancer diagnosis. Approximately 2/3 of this better survival number is attributed to the earlier diagnosis made possible from yearly mammographic screening.
A mammogram is used to detect breast cancer before it gets to a size that you can feel. When a breast cancer is found early there are better outcomes; including more treatment options and reducing a women’s risk of dying from breast cancer. Mammography as a public screening tool has been a great success, but there are some worrisome trends.
This year, the Centers for Disease Control and Prevention (CDC) released a study indicating that from 2000-2006, the number of women getting mammograms dropped in 34 states by approximately 5%. With the current economic state of affairs, the numbers of women getting their annual mammogram are sure to have decreased even more. It is true that breast cancer death rates have gone down since mammograms became a routine test for women, especially over the age of 40, but it can be noted that approximately 35 percent of women in the United States have not had a mammogram within the past two years. It bears noting here that a mammogram at BMH can now be scheduled almost immediately by calling 802-251-8431.
There is another concern with the mammogram rates dropping. After increasing for more than two decades, the incidence of female breast cancer decreased by about 2% per year from 1999 to 2006. A two percent drop means about 15,000 deaths were avoided in 2009 alone! The reason for this drop is felt to be at least partly due to less use of hormonal replacement therapy (HRT) after menopause following the publication of the Women’s Health Initiative in 2002.
However, another more ominous contribution to the drop may be due to less women getting mammograms. Mammograms will often discover breast cancer many years earlier than we are able to feel it. If a large number of women stop getting mammograms, it will look like the incidence of the disease is dropping. In reality, we are just delaying the diagnoses. As time goes by, not only will the number of breast cancers rise, but these will be larger, more advanced cancers that will be harder to cure and likely cost society a lot more money than any amount saved by not getting mammograms.
It has been said (by George Santayana), “Those who can not remember the past are condemned to repeat it.” Having been a healthcare provider before, during, and since wide spread mammographic screening, it has been an amazing experience to see how much progress has been made in helping women beat this awful disease. These gains have to a very large extent followed the early diagnoses we can often make with mammograms. It would be tragic to see us lose what we have accomplished.
In these hard financial times, it is not unusual to hear people putting off healthcare exams. But there is help. The Vermont Department of Public Health has a program called Ladies First to help women get their yearly clinical breast exams, yearly mammograms, pap tests, screenings for cholesterol, and blood pressure checks. For information about this program or other breast health questions, you can call Kelly McCue, RN, OCN, CHPN, Nurse Navigator for the Comprehensive Breast Care Program at Brattleboro Memorial Hospital, 802-251-8437. Or, you can call Ladies First at 800-508-2222.
Dr. Rosen, a member of the American Society of Breast Surgeons, will be publishing an article about the controversy of new guidelines recently put forth by a government task force in the near future. In the meantime, he suggests the browser go to organization’s website at http://www.breastsurgeons.org/news/article.php?id=57 to read about the Society’s stance on the subject.
Dr. Rosen is a member of the BMH Medical Staff. He is a general surgeon with a subspecialty in breast health and surgery, and serves as Medical Director of the BMH Comprehensive Breast Care Program.