How many women do you know? Odds are that one in 10 o them will develop breast cancer. About one-fourth of that number will die as a result of the disease.
For reasons we don't completely understand, Maryland women have a slightly higher rate of breast cancer than the national average. Two new state programs aimed at women who are underinsured or have no insurance should help prevent deaths from breast cancer.
Administered through the Maryland Health Services Cost Review Commission, the "Coordinated Breast Cancer Screening Program" involves a network of 29 hospitals around the state. The second comes as a result of a $3-million-a-year grant over five years from the Centers for Disease Control and Prevention and is a coordinated breast cancer and cervical cancer screening program.
Q: Why are screenings so important in breast cancer?
A: Early detection saves lives because intervention can prevent the cancer from spreading to other parts of the body. Mammograms and clinical breast exams remain the most effective tools for detecting breast cancer. Their use can reduce mortality by as much as 30 percent.
Q: Who gets breast cancer?
A: Most cases are not related to any known risk factor, although we know there is an increased risk for women as they age. For example, there is a 50-fold increase from the ages of 25 to 80. That's why the American Cancer Society recommends increased screenings as women get older.
More white women than black have the disease and poor women are at greater risk. Women who have their first pregnancy at a later age show a higher incidence, as do those with a family member who had breast cancer before menopause.
Q: Does diet play a role?
A: Scientists still aren't clear on a connection between what we eat and breast cancer.
Q: What are current recommendations for screening?
A: Clinical breast examination and mammography are needed. Recommendations for screening change with a woman's age. From 40-49, the American Cancer Society recommends an examination once a year and a mammogram every one or two years. From age 50, women are advised to have an examination and mammogram every year.
Q: What if a woman has a particular risk factor?
A: She may need more frequent screenings, but her physician should guide her in those decisions.
Q: What keeps women from getting screenings?
A: There are a lot of myths and excuses that prevent women from getting adequate screening. For example, some people believe that women aren't aware of mammography and its benefits. Research shows that 98 percent of women in Maryland have heard of the test. Many women say their physicians won't refer them for mammograms, when research shows 85 percent of doctors say they refer their patients for screenings when they meet the standard criteria.
Furthermore, there is a high number of mammography units in Maryland for the size of its female population. And although the ++ procedure is expensive, there are increased sources of funding to allow poor women to have mammograms.
Q: How many Maryland women above 40 have annual mammograms?
A: Nearly 40 percent report having the screenings in the last year.
Q: If a woman wants breast cancer screenings but cannot afford them, what should she do?
A: Call your local chapter of the cancer society and ask for information about the breast cancer screening programs offered through the Health Services Cost Review Commission.
For more information on breast cancer and the important role of screenings, call the ACS toll-free number (800) 227-2345.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.