Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, October 18, 1993 TAG: 9310180017
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: CAROLYN CLICK STAFF WRITER
DATELINE: LENGTH: Long
One in eight women will get breast cancer.
Every 12 minutes, a woman dies of breast cancer.
Every three minutes, a woman is diagnosed with breast cancer.
This year, 182,000 cases of breast cancer will be diagnosed in American women, and 46,000 women will die from the disease.
The drumbeat of bad news goes on month after month, repeated in popular women's magazines, in the workplace, at day-care centers, at home - anyplace women gather.
But doctors suggest taking a closer look at the numbers: Behind the raw data, behind the education movement that has led more women to perform breast self-exams and get mammograms, there is room for hope.
Dr. William Fintel, a Roanoke oncologist, cringes every time he hears the "1-in-8" statistic.
"It's because you can do whatever you want with statistics," Fintel said. "It doesn't hit 1-in-8 until [age] 90.
"If you are sitting in a room of 100-year-olds, yes, then [the chance of developing the disease] is 1-in-8," Fintel said.
Dr. Marshall Wakat, a Roanoke radiologist, said the latest increase in lifetime risk as forecast by the National Cancer Institute - from a 1-in-9 chance to 1-in-8 - "had absolutely nothing to do with the incidence of breast cancer."
Instead, it was based on new mortality studies that showed an increased average life span for women.
There is even disagreement about the lifetime statistic among the leading organizations fighting the disease. The National Cancer Institute uses the 1-in-8 statistic, while the American Cancer Society has remained with the 1-in-9 chance.
In a memo to its division executives, the American Cancer Society explained the difference this way: The ACS ends the risk calculation at age 85, while the NCI extended the age limit to 95-plus to include the small probability of surviving that long, then developing cancer.
"Both `1-in-9' and `1-in-8' are correct," the memo noted. "A woman today has a 1-in-9 chance of developing breast cancer by age 85 and a 1-in-8 chance of developing breast cancer beyond age 95. The two estimates are from the same source of data."
But what are the odds for women at specific ages? The American College of Obstetricians and Gynecologists says women at age 30 have a 1-in-2,525 chance of developing the disease; at age 40, a 1-in-217 chance; and at age 50, a 1-in-50 chance.
If those numbers are slightly more reassuring, especially for women under 50, then why does it seem that we hear about more and more people with the disease?
The incidence continues to rise, scientists say, but they also suggest increased use of early detection tools such as mammography and breast self-examination is swelling the ranks of those diagnosed with the disease.
Indeed, scientists who reported the dramatic increase in incidence of breast cancer between 1982 and 1987 say the decline in cases after 1987 may be linked, in part, to the availability and use of mammography screening in the 1980s.
That phenomenon is known in scientific circles as "lead-time bias," Fintel said. "You haven't found any more cases, you've just detected them earlier.
"There is not a doubt in my mind that awareness of the breast as a friend and potential foe lead women to early detection," Fintel said. "We see a large number of increases in cases, but not a large number of increases in deaths. That means we are finding them and fixing them."
Doctors believe the earlier onset of menstruation and the delay of menopause in modern women may increase the risk of breast cancer because of higher estrogen production over a lifetime.
Women are also delaying childbirth and having fewer children, Wakat said, which is seen as a contributing factor.
And the postwar baby boomers, those riding the huge wave of humanity that has defined the popular culture for more than two decades, are also getting older.
"Breast cancer is a very rare disease at 40," Wakat said. "The incidence of breast cancer increases quite rapidly between 40 and 50."
Now that many of the baby boomers are well into their fifth decade, there are more reports of breast cancer in the 40-50 age category.
Doctors say there is no question that early detection improves chances for survival. Wakat has seen that firsthand.
He has worked with Swedish physician Laslow Tabar in the largest controlled study of mammography in the world.
The community they studied is Falun, Sweden, a city of 300,000 that Wakat said reminds him in many ways of Roanoke. The population has remained very stable, with little of the movement that characterizes American society.
Fifteen years ago, the women of the town recruited Tabar to conduct a study of breast cancer. The study population was 135,000 women. Two-thirds received mammography screening; one-third did not, serving as the control group. (After six years, the control population was offered screening.)
"They have been able to prove a 31 percent difference in the death rate between those screened and those unscreened," Wakat said. "Those statistics still hold up 15 years later."
With mammography, radiologists are able to detect tumors that are not large enough to be felt - even when patients are faithful about conducting monthly self-examinations.
For tumors less than 1 centimeter in size, Tabar's results show a 95 percent to 98 percent cure rate.
"The overwhelming criterion is size," Wakat said. "In general, a lesion has to be 2 to 2 1/2 centimeters in size to feel it. That is when [tumors] go crazy; you are talking about 20 to 30 percent of it being metastasized."
Mammography isn't perfect, and questions still linger among scientists about the need for regular mammograms for women in the 40-49 age group.
But doctors and the American Cancer Society continue to recommend a baseline screening at age 40, and follow-up mammograms every other year until age 50 and every year after age 50.
The mammography procedure involves an X-ray of each breast. As the patient stands by the machine, the breast is placed between two plastic plates, squeezed until the tissue is somewhat spread out and then X-rayed. It is relatively painless for most women, although some have said they experience momentary discomfort. The compression lasts only a few seconds.
The mammogram should be coupled with monthly self-exams and an annual breast exam by a physician.
Ann Wilson of Roanoke knows the value of early detection. Although she had a mammogram some time in the late 1980s, she postponed any follow-ups until her doctor insisted she go for the procedure last year.
"I probably would have put it off again, if the doctor hadn't said, `When was your last mammogram?' " the 55-year-old Wilson said. "If he had not pushed me then, I probably would not have gone."
Although the mammogram did not reveal a tumor, doctors found "micro-calcifications" on the X-ray that signaled a problem.
"They show up on the mammogram almost like little dots," Wilson said. "Somehow, the configuration told them where a problem area might be."
Three surgeries followed. The first time, surgeons removed cancerous tissue; the second time, they removed three lymph nodes that had become involved; the third time, part of her breast.
The surgeries were followed up by radiation and chemotherapy.
"I feel really great," said Wilson, who returns every few months for tests. So far, there has been no recurrence of the disease.
Wilson remains a staunch advocate of breast-screening, a procedure she always supported but almost failed to work into her full schedule.
"I felt very strongly about [mammography]," she said, "even when I didn't have it done. We just all get busy."
by CNB