October 27, 2001
the Good News: More Women Are Surviving Breast Cancer
By Leah Shafer
a major killer of women, breast cancer is a scary prospect indeed.
Would you be surprised to find out that most women survive it? They
do. During the year 2000, 40,800 women will die of the disease,
which means that more than triple that number -- 142,000 -- will
become breast cancer survivors.
The past decades and the millions of dollars spent on breast cancer
research annually have brought major breakthroughs in combating
the disease, and today women have a good chance of beating breast
cancer if they stay aware of their breast health. Doctors now know
ways to decrease breast cancer risk, have effective methods of early
detection, and offer more aggressive treatment regimens than ever
Screening takes on new importance
Some of the biggest improvements in breast cancer care have come
in the field of early detection. A mammogram, which is an X ray
of the breast, can detect tumors too small to be felt -- thereby
giving women a head start on treatment. And this kind of head start
has powerful results; if found early, breast cancer has a five-year
survival rate of over 95 percent.
Consequently, it's heartening to hear that 69 percent of women
over 50 years old received a mammogram in 1998. That number was
only 27 percent in 1987.
But mammograms are only as good as the machines that take them
and the physicians who read them. To recognize the need for tighter
quality control, Congress established the Mammography Quality Standards
Act in 1992 and reauthorized it in 1998. The act licenses all mammography
facilities in the United States based on accurate interpretation
of mammograms, qualified personnel, and equipment that meets radiological
standards set by the U.S. Food and Drug Administration. "Physicians
have to receive extensive training, both initially and on the job,
to read mammograms," said Nancy C. Lee, M.D., director of the division
of cancer prevention and control at the U.S. Centers for Disease
Control and Prevention (CDC). "This is compared with the 1980s,
when there were few training requirements for doctors who read mammograms."
Even with access to a quality mammogram, some women face financial
barriers. The cost can be prohibitive for women without insurance,
and even women with insurance can face deductibles so high that
annual mammograms are unaffordable. The good news is that organizations
like the Susan G. Komen Foundation, the U.S. Health Department,
the American Cancer Society, Planned Parenthood, and the YWCA's
Encore Plus Program have stepped up to the plate to offer low-cost
or free screening programs.
The first and biggest low-cost screening program is the National
Breast and Cervical Cancer Early Detection Program, supported and
administered by the CDC and implemented throughout the country.
Since 1990, the program has provided nearly 1.2 million low-cost
or free mammograms and has diagnosed almost 8,000 cases of breast
cancer, said Steve Reynolds, a public health advisor for the CDC.
The program is particularly valuable because it educates and screens
women who are not as likely to get medical care, such as women with
low incomes, uninsured women, those belonging to a racial or ethnic
minority group, and women who have a language barrier. "We are reaching
women who are underserved, who are not getting mammograms -- this
is the key," Reynolds explains.
During the year 2000, 40,800 women will die of [breast
cancer], which means that more than triple that number
-- 142,000 -- will become breast cancer survivors.
It's not only the uninsured who needed help getting access to this
medical service; in 1985, Illinois and Virginia were the only two
states to require insurance coverage of mammograms. But since then
more states have stepped in with legislation that compels insurance
companies to cover mammograms. As of July 2000, every state except
Utah requires it. Medicare began covering annual mammography and
treatment for breast cancer in 1991 for women over 40.
To find out where to get a low-cost mammogram in your area, see
the links at the end of this article.
Pills for prevention
For women at an increased risk of breast cancer -- those with a
strong family history of the disease, for example -- prevention
used to be an illusive goal. It is still a difficult proposition,
but there is good news about preventive treatments. Six years after
it started, the Breast Cancer Prevention Trial showed that women
taking the drug tamoxifen (Evista) had a 49 percent reduction in
One of the largest breast cancer prevention trials ever undertaken
is currently recruiting participants in the United States, Puerto
Rico, and Canada. The Study of Tamoxifen and Raloxifene, or STAR,
will look at 22,000 postmenopausal high-risk women to establish
if raloxifene (Nolvadex), an osteoporosis-prevention drug, is as
effective as tamoxifen in reducing the incidence of breast cancer.
Follow the money
The national outpouring of support for breast cancer research like
STAR has been nothing short of astonishing. For example, the Lee
National Denim Day in October 2000, which included some 18,000 companies
and 1.5 million individuals, raised more than $6 million to fight
breast cancer. Nine states allow taxpayers to make contributions
to breast cancer research or to screening and education programs
on their income-tax forms. The breast cancer stamp has raised nearly
$16 million dollars for research since the summer of 1998. And the
granddaddy of them all, federal funding for breast cancer research,
has grown 600 percent since 1991, from $92.7 million to $660 million
Live long and prosper
Perhaps the best news is that death rates from breast cancer showed
their first significant decline between 1992 and 1996, dropping
1.8 percent each year. This drop in mortality is probably due to
two factors: earlier detection and better treatment, Dr. Lee said.
The largest decreases occurred in younger women, both African American
It's exciting to see these decreases, and Dr. Lee points out that
the key to continuing this trend is getting women to pay attention
to their breast health and get annual exams. "We know how to save
lots of lives, but we know that there are many women who are not
-- for whatever reason -- taking advantage of mammography," Dr.
Lee says. "It's very important to disseminate this prevention message
to the population."
The next few years will hold some exciting advances in treatment
of breast cancer. Researchers are studying everything from hormone
replacement therapy, diet, and exercise, to improved chemotherapeutic
combinations, and methods of detection.
One intriguing but distant possibility is a test for cancer biomarkers
in the blood. This test would look for unique proteins or chemicals
in the blood that indicate a small cancer somewhere in the body.
Australian researchers recently discovered a protein marker in tears
-- called Lg -- that is found in many cases of breast and prostate
Until these types of tests are available, the best option is still
early detection. A mammogram can detect a cancerous lump in the
breast two years before you can feel it. "What if we could find
it four years before a woman could feel it? If we can find the cancer
earlier, then we can treat it earlier," Dr. Lee says. "We should
keep looking for that better test, but we must apply what we know
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