Breast Care: an update
Monday, Oct. 22 - Mammograms

(TRANSCRIPT - AS AIRED)

In the past several years there has been a tremendous push to make the public aware of breast cancer. The primary focus of this media campaign was to urge women over 40 to get annual mammograms.

The benefit of a screening mammogram has been proven in women greater than age 50 to reduce their risk of dying from breast cancer by at least 30%.

Having a mammogram and detecting the cancer when it’s small and early before it has a chance to spread anywhere we believe is still one of our best treatment options for the patient and so recommending that they get their mammogram every year to check.

Women should have a baseline mammogram at 40 and then every year after that.

Early detection is definitely the key. I mean that’s the reason to do it year after year. If you had a diagnosis and you find it early it makes a huge difference than waiting until you have the symptoms.

A mammogram every year is going to increase the likelihood of finding a lump when it’s still very small in the early stages when treatment is very successful. It feels extra tragic when a younger woman develops breast cancer, but, in reality, 77% of all breast cancers develop in women over the age of 50 and 18% are developed in women who are 40-50.

Despite this campaign and its recommendations from breast cancer surgeons and oncologists, the American Cancer Society, and many health care providers, statistics are showing a decline in mammography use. In the last several years fewer women are getting their annual mammogram. I asked Bob Nugent, Senior Director of Cancer Control at the American Cancer Society’s Eastern Division, what he thinks are some of the reasons for this.

"Insurance status, time spent out of the workplace, fear of pain, fear of a result, positive or negative, this cuts across educational level. So as you think of people who are not getting screened this is someone with a college degree is just as soon not to be screened as someone with a high school diploma or without a high school diploma. If a woman feels that she is going to impact her work negatively by taking a day off to go and get screened that’s an issue. If the results of that screening aren’t returned to her within three or four days, you know what, that’s an issue too because no one should have to wait for the results."

"From my experience a lot of it is money and just not having the funds." (Beth Slater, a representative of the Healthy Living Partnership in New York State). "And it feels like a luxury to some people to get one when they’re having difficulty paying for groceries or the rent or a mortgage."

Another reason often given anecdotally is that women don’t like to be, as they say, squeezed.
"There really should be no reason. The digital mammograms I think are even less uncomfortable to have. I do not have patients complain about mammograms being uncomfortable anymore." (Dr. Janet Muhich, Breast Cancer Surgeon and Chief Medical Administrator at Lourdes Breast Care Center in Binghamton, New York.) "You know it’s the same amount of pressure, but it’s just a gentler feel to it when it releases. They use a pad now that they put right on the bottom plate that’s a cushion so that’s always done for all mammograms in town."

What about the concern of exposure to radiation during a mammogram?

"The radiation from a mammogram is very small and part of it is that’s part of the reason why they compress the breast tissue. If you compress the breast tissue you need less radiation to penetrate the breast. So when people complain about the compression there is a reason for that. So it’s a very small amount of radiation and really does not increase the risk for breast cancer."

For this report my colleague Carolyn invited me to record her mammogram experience. We’ll hear the technician getting Carolyn positioned for one image, the actual compression, and the shrill beep of the image being taken. You may be surprised how quick it really is.

"Because I’ve been here before I noticed this new machine. She said it’s a new digital machine. What I see differently is there’s this pad there to make it warm because it was always so cold."

"Right. This is separate from the digital. They included a pad for every patient. It makes it, if nothing more, it makes it warmer and softer. It’s a little more comfortable."

"A little more comfortable. That’s good."

"It gets rid of the hard edges."

"OK."

"OK, I need to put a nipple marker on each breast. I’d like you to come stand in front just so we can see where your nipples are on the x-ray. OK, face the plate for me. Come right in front. All you have to do is stand in front for all four views. I want you to put your left hand up here and hang onto the rail. Put your right hand down by your side. We’re going to do your right breast first. Take a step to your left. There you go. I’m going to raise the machine to the level of your breast and you’re just going to lean in. OK, here comes the compression. Let me know if it’s more than you can tolerate. I’m going to do it by hand. Put your head to the side. Are you OK?"

"Well, it does hurt."

"OK. I can back it up a little bit. OK, just hold still. [Machine beeps] OK, Carolyn, you can relax. I have to look at this picture before we can do the same thing to your left breast."

Advances have been made for the mammogram to be quicker, less uncomfortable, and more accurate. The time, even if you include travel, can be an hour or less. And sometimes the mammography services can come directly to you.

"Many of the partnerships have state-funded or privately grant-funded mammogram vans which are vans that travel that have the capacity to do mammograms right there in the parking lot. You know, someone can just walk out and get their appointment." (That’s Jan Chytillo, Director of Health Promotion at the Cancer Society’s Eastern Division.)

Besides time and transportation the cost of a mammogram if you are not insured or have a high deductible is also often an issue.

(Again, Beth Slater) "I’m from Healthy Living Partnership. We offer free breast, cervical, and colorectal cancer services to anybody who doesn’t have insurance or if you have insurance that doesn’t cover these services or if you have a high deductible. It’s free and it’s very easy to sign up. It just takes a couple of minutes. What to me is so wonderful is that it’s so easy to qualify. It’s designed to serve people who wouldn’t otherwise be able to get screened or it would cost them the money that goes toward their groceries or their mortgage or their rent. Most of the people we serve are working and they just either can’t afford the insurance or they have limited insurance and high deductibles.

"I think there’s an element of being your own health care advocate." (Bob Nugent) "You really have to take a look at it, almost an intellectual look at your own body and realize there’s things I have to do for myself. There’s a large element in breast cancer, that it really is a self-awareness and self-education and self-initiative."

"When you see a patient who comes in the office with a large tumor," (Medical Oncologist Ronald Harris) "and at that stage the tumor’s advanced, you know that the tumor has been there for a while. Many times there are skin changes or there are visible lumps or masses. It really is disheartening because in that instance you almost feel as if the medical system has failed the patient in that they have not received their screening or they have not pursued treatment for something that would be potentially curable at an earlier time."

(Susan Kost, Director of the Breast Case Center at Wilson Hospital in Binghamton, New York) "Daily I talk to women who are 10, 15, 20 year survivors having wonderful full lives that have important stories to tell us... which is get in, get treated, and get the care that you need so that you can be like them."

The Breast Care and Update Series is made possible through a grant from the Susan G. Komen Foundation. For WSKG, I’m Kathleen Cook.