Sunday, May 18, 2003

Mammograms matter of life and death

We don't have to know each other very well before we ask The Question.

How did you find yours?

Not that those of us who have been diagnosed with breast cancer don't have other questions, but that's one of the first ones we ask each other. "A mammogram. They found it when I had a mammogram."

I don't know how often I've heard that answer. A lot. Half the time? Forty percent of the time? I'm not sure, although we cancer survivors become very attached to percentages. An 80 percent survival rate starts to sound pretty good, even though only yesterday you were 100 percent sure you felt just fine. Losing 50 percent of your breasts and 100 percent of your hair? Shocking news but we have already started playing the percentages in earnest.

We want to live.

A healthy pinch

Breast cancer can kill you. One in eight women will get it, but there's a test to find out whether you have it. The test is safe, easy to get, inexpensive. Mammograms are bloodless and painless. OK, it pinches a little. The breast is squeezed between two plates to spread the tissue apart, allowing a lower dose of radiation. So, while somebody being treated for cancer might receive thousands of rads, a woman who has yearly mammograms from age 40 until age 90 will only have had between 20 and 40 rads.

Yet the debate continues.

In 1997, a National Cancer Institute (NCI) panel examined pounds of paper and hours of testimony and found itself unable to decide whether women in their 40s should have mammograms. Women in their 40s were deemed "statistically insignificant" and prolonging their lives was not cost effective, according to the report.

The NCI now advises women in their 40s to have a mammogram every year or two. The American Cancer Society recommends annual screenings for that age group, and last week issued new guidelines making an even stronger recommendation for mammograms.

"We have more data, we have better data," Debbie Saslow, ACS director of breast and gynecologic cancers, said Thursday. "The benefit is particularly clear for women in their 40s."

The guidelines also suggest that physical examinations of the breast by the woman herself or a health care professional are important, but by the time a lump can be felt, "it's likely to have been there for quite some time, and the longer it's been there undetected, the more chance it's had to grow and spread," Saslow said.

According to the latest issue of CA: A Cancer Journal for Clinicians, if breast cancer is discovered when it hasn't spread to the lymph nodes, the five-year survival rate is 97 percent. If the cancer has spread to underarm lymph nodes, the rate drops to 76 percent. If the cancer has metastasized, the five-year survival rate is 20 percent.

As the distinguished radiologist Dr. Myron Moskowitz told me several years ago with a tired sigh, "The only way to find it early is to look for it early."

A mammogram?

It's a silly question when you consider the percentages.

E-mail or phone 768-8393.

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