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October 27, 2001
Here's the Good News: More Women Are Surviving Breast Cancer

By Leah Shafer

Jason Stout

s 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 before.

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 breast cancer.

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 in 1999.

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 and Caucasian.

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."

What's next?

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 cancer.

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 now."

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