Next: Breast Cancer Treatment

Widespread screening programs for women 50 and over can reduce breast cancer death rates by 30 percent. A new analysis of a study by the Health Insurance Plan of Greater New York published by the National Cancer Institute (NCI) in 1988 showed that mammographic screening can also reduce breast cancer death by 24 percent in women 40 to 49.

Mammography is the best method available for detecting tumors in their early stages. It can detect 85 to 90 percent of breast cancers in women over 50 and can discover a tumor up to two years before a doctor or patient would otherwise know it's there.

It appears that government and health organization programs encouraging women to get mammograms are beginning to pay off. A recent survey of 980 women conducted by the Jacobs Institute of Women's Health and the National Cancer Institute (NCI) showed that 64 percent of women 40 and over have had at least one mammogram, up from 37 percent in 1987.

Twelve medical organizations — including the National Cancer Institute, the American Cancer Society, and the American Medical Association — recommend that women between the ages of 40 and 49 have their breasts examined by their doctors yearly and get a mammogram every one to two years. Starting at age 50, the mammogram should also be done yearly. These guidelines apply to women who have no symptoms of breast cancer, such as a lump or other change in the breast. A woman with symptoms should see her doctor immediately. And, for some women who have no symptoms but may be at higher risk for the disease, a physician may recommend more frequent mammograms.

Even though more women are getting mammograms, only 31 percent are following the guidelines, and, according to a report in the Centers for Disease Control's Morbidity and Mortality Weekly Report of Sept. 14, 1990, "if death rates are to be decreased, mammography use rates must continue to increase, and women must return for repeat mammograms at recommended intervals."

Nearly three-fourths of women in the Jacobs Institute survey who had had a mammogram did so because their doctors recommended it. Almost half the women (45 percent) who had never had a mammogram said their doctors never recommended it.

Of the women who had never had a mammogram, reasons cited were that they had no family history or that they were not at risk, usually meaning they thought mammograms were important only for women who feel a lump or have other symptoms of breast cancer. Many said that mammograms cost too much. Another reason given was fear of radiation.

Of the women who had one mammogram but did not follow the recommended guidelines, 35 percent stopped because the first mammogram was negative and therefore they felt they didn't need any more. Some women cited cost, a lack of family history of the disease, and fear of radiation as reasons for not continuing care.

The expense of mammograms is being addressed by local efforts to reduce cost and by legislation in a growing number of states. As of July 1990, 29 states required insurance companies to provide some level of coverage for mammography screening.

Mammography quality has improved significantly in the last six years. Results of state surveys supported by FDA found that the average score of images produced by the machines climbed from 7.8 in 1985 to 9.9 in 1990. (The range of scores is 0 to 16, with a score of 8 considered acceptable.) The survey results were reported in the November 1990 issue of the journal Radiology. The authors, Fred G. Reuter, D.Sc., and other scientists from FDA's Center for Devices and Radiological Health, attributed the better image quality now achieved partly to use of equipment dedicated to mammography rather than general x-ray use, improved techniques and film processing, and the development of more sensitive screen and film systems.

The improved images necessitated only a slight increase in radiation to the patient, and the radiation levels remained well within generally accepted safety guidelines. In fact, the levels were about two-thirds lower than those found in a 1979 survey. According to the researchers, the benefits of improved image quality far outweigh the slight increase in radiation. FDA is conducting research on ways to further improve mammography, and it plans to support state radiation control agencies on their survey of mammography equipment and practices in 1992.

When selecting a mammography facility, women should find out if it is accredited by the American College of Radiology (ACR). The ACR accredits facilities based on evaluation of equipment, film processing, and the credentials and experience of the technologists who take the mammograms and the radiologists who interpret them. Women who have breast implants should ask the facility if they use special mammography techniques designed for women with breast implants. To find an accredited facility or to get other information on mammography, call the NCI Cancer Information Service toll-free at 1-800-4-CANCER or a local chapter of the American Cancer Society.

Breast Self-Examination (BSE)

Breast self-examination should be done once a month so you become familiar with the usual appearance and feel of your breasts. Familiarity makes it easier to notice any changes in the breast from one month to another. Early discovery of a change from what is "normal" is the main idea behind BSE. If you menstruate, the best time to do BSE is two or three days after your period ends, when your breasts are least likely to be tender or swollen. If you no longer menstruate, pick a day, such as the first day of the month, to remind yourself it is time to do BSE.

1. Stand before a mirror. Inspect both breasts for anything unusual, such as any discharge from the nipples, puckering, dimpling, or scaling of the skin.

The next two steps are designed to emphasize any change in the shape or contour of your breasts. As you do them, you should be able to feel your chest muscles tighten.

2. Watching closely in the mirror, clasp hands behind your head and press hands forward.

3. Next, press hands firmly on hips and bow slightly toward the mirror as you pull your shoulders and elbows forward.

Some women do the next part of the exam in the shower. Fingers glide over soapy skin, making it easy to concentrate on the texture underneath.

4. Raise your left arm. Use three or four fingers of your right hand to explore your left breast firmly, carefully, and thoroughly. Beginning at the outer edge, press the flat part of your fingers in small circles, moving the circles slowly around the breast. Gradually work toward the nipple. Be sure to cover the entire breast. Pay special attention to the area between the breast and the armpit, including the armpit itself. Feel for any unusual lump or mass under the skin.

5. Gently squeeze the nipple and look for a discharge. Repeat the exam on your right breast. (If you have any discharge during the month — whether or not it is during BSE — see your doctor.)

6. Steps 4 and 5 should be repeated lying down. Lie flat on your back, left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Use the same circular motion described earlier. Repeat on your right breast.

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Tags: Breast Cancer

About the Author

FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.