Sounding a wake-up call about getting mammograms


September 21, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

At this moment there are 2.5 million women in the United States with breast cancer. Approximately 1 million of these women don't even know they have it.

Those numbers are frightening in a world where breast cancer is the most common type of cancer in women and the second leading cause of cancer death after lung cancer. That is why most women's health organizations recommend that all women 40 and older have clinical breast examinations annually. This examination should be coupled with mammograms every year for women over 50 and every one to two years for women aged 40 to 49.

Q: How important is getting a mammogram?

A: Mammography reduces deaths from breast cancer by 30 percent. The good news is that with mammography the cancers will be discovered in the early stages when they are small and localized. These cancers have a five-year survival rate of 91 percent.

When you compare that with a 70 percent rate for women with locally spreading lesions and 19 percent for cancers that have spread to other parts of the body, getting a mammogram becomes an excellent investment of time and money. Until scientists can determine the cause of breast cancer, early detection to prevent death is our only recourse.

Q: Why must you have both a breast examination and a mammogram?

A: Mammograms may miss up to 20 percent of cancers that can be felt by a doctor. Lesions that can be felt are comparatively large, usually about 2 centimeters (three quarters of an inch). Ideally, screening programs would find lesions smaller than 2 centimeters. Mammograms are three times as likely to be able to do that.

Q: Why do women need annual exams?

A: During the first mammography a woman has a slightly higher chance that the examination will reveal a tumor because the first exam may find a cancer that has been growing for several years but has gone undetected, as well as those cancers that have recently developed.

After the first exam, all subsequent tests will only identify those .. small cancers which have started between tests and which will not have had time to grow and spread. Repeated mammograms have been shown to reduce the rate of death from breast cancer.

Q: Does participation in a screening program guarantee that I won't get cancer?

OC A: No. Screening programs detect cancers -- they do not prevent

them. Women must also remember that these procedures are not perfect. For instance, mammograms will also detect non-cancerous lumps. About 50 percent of all women may have a lump at some time in their life, but 80 percent to 92 percent of these will be non-cancerous. Mammograms may also miss cancers that will show up later.

Q: Why don't all women receive annual mammograms?

A: About 30 percent of the women who have never had a mammogram have said their doctors never told them about the importance of having one. Another 40 percent have indicated they did not know about the procedure. Since it is clear there are physicians who are not making sure their patients have this procedure, women must take responsibility for getting this lifesaving test.

Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.

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