THE VIRGINIAN-PILOT
Copyright (c) 1997, Landmark Communications, Inc.
DATE: Monday, February 10, 1997 TAG: 9702080098
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 126 lines
CONNIE POWELL and Eloise Bass are best friends who do nearly everything together. They even work together as bus drivers for the Virginia Beach school system. Last week,, they went together for their first mammogram.
Powell, 48, and Bass, 43, were nervous as they climbed aboard the Sentara mobile mammography unit, parked in front of the Virginia Beach Central Library.
``I heard they hurt,'' said Powell, clutching her oversized plastic coffee mug.
Fifteen minutes later, however, her attitude had changed, and she said: ``It wasn't too bad. It just felt a little squishy. I feel a little stretched.''
But did she even need the mammogram? Or should she have waited until age 50?
It's one of the shrillest debates in health care: When should women begin having screening mammograms to detect breast cancer, which kills 46,000 women a year, including about 1,000 in Virginia?
Last month, after reviewing more than 100 scientific articles, a panel of experts appointed by the National Cancer Institute reported that there is still not enough evidence to justify a government recommendation that all women in their 40s get an annual mammogram.
``Each woman should decide for herself whether to undergo mammography,'' the panel concluded.
The recommendation shocked and angered women's health experts and was immediately dismissed by the cancer institute's own director and by the American Cancer Society.
``The data supporting the benefit of screening women in their 40s is stronger than it had been,'' said the institute's director, Dr. Richard Klausner. ``Women need to know that.''
To those who work every day in the women's health field, and who know breast cancer intimately, the panel's recommendation was nothing short of criminal.
``It just doesn't make good sense,'' said Nancy Schreier of the Virginia Breast Cancer Foundation. Schreier, 55, was diagnosed with breast cancer eight years ago after a routine mammogram. If she'd followed the panel's recommendation, she said, she'd probably be dead by now.
``Any woman you talk to who had a mammogram in her 40s that picked up the cancer will say the same thing,'' Schreier said.
``I think the panel absolutely blew it completely,'' said Dr. Willette J. LeHew, who chairs the Virginia chapter of the American College of Obstetricians and Gynecologists. The college, along with the American Cancer Society and the American College of Radiologists, recommends women have a baseline mammogram between ages 35 and 40, a routine mammogram every one-to-two years after that, and annual mammograms beginning at age 50.
``I feel very strongly that mammograms should be done on this basis,'' LeHew said. As for the panel's comments that more frequent mammograms before age 50 are not cost effective, LeHew notes that it takes just one early diagnosis - the earlier breast cancer is diagnosed the more treatable it is - to make early mammograms worth-while.
LeHew's preference appears to be the generally accepted community standard for Hampton Roads.
When Sentara Health System convened a panel of local OB/GYNs to determine mammogram guidelines for the system's 200,000 managed-care members, the doctors' recommendation mirrored the national OB/GYN association's, said medical director Randy Axelrod.
``I am hell-bent on having women get mammograms at the appropriate time,'' Axelrod said. ``The best way to prevent aggressive or invasive stages of this disease is to detect it early, yet everywhere we don't have the types of mammography rates we should have.''
And dithering recommendations like the cancer panel's just confuse women more, say women's health advocates.
Axelrod takes a proactive approach. He recently began a program in which every woman aged 40 and older in a Sentara plan receives a birthday card reminding her of the importance of regular mammograms.
It's a stance he wishes more employers would take.
Some do. On a rainy morning last week, the Sentara mobile mammography unit was jammed with Virginia Beach city and school employees. Twelve women were screened in three hours. Each said she was there because of the information packet she'd received from her employer.
In addition to promising a free sweatshirt for completing the mammogram, the city and school system, as part of their wellness program, pay at least part of the $72 cost of the mammogram for women who don't have insurance.
``I would have dragged my butt a lot longer'' if not for the school system's promotion, Powell said.
Shirley Wood, 41, a secretary at Thalia Elementary School, almost canceled her mammogram last week. Another secretary was out sick, all hell was breaking loose in the office, and she just didn't think she had time to pop over for the test.
Then she thought about a co-worker who had just scheduled a biopsy to check out a suspicious spot found during a mammogram.
Wood decided she had time.
As the women sat in the tiny mauve and gray waiting area of the van, they spoke intimately of shared experiences.
They talked freely of their own breasts, menstrual cycles, women they knew who had felt lumps, found cancers, lost breasts - or lives - to this disease.
Women who were on their second, third or even 10th mammogram reassured the newcomers that the procedure didn't hurt.
And radiology technicians Claudia Alexander and Kim Barker did their part to dispel many myths about mammograms - like the bigger the breasts, the more it hurts.
Not true, Alexander said. Mammograms are sometimes uncomfortable because very dense breast tissue forces the technician to press harder on the breast to get a clear image. ``Size has nothing to do with it,'' Alexander said.
Alexander and Barker, certified mammography technicians with more than three decades of mammogram experience between them, are tireless educators and advocates for the women they test.
Ask either of them what they think about the cancer panel's recommendations and they frown and turn their thumbs down.
Breast cancer, Alexander says, is the leading cause of premature death of women in their 40s. ``I think that says it all,'' she concluded. ILLUSTRATION: KEN WRIGHT
The Virginian-Pilot
WHAT THE AMERICAN CANCER SOCIETY ADVISES
Routine breast cancer screening should include monthly breast
self-examinations, breast examinations by physicians and
mammography.
Mammography can detect 90 to 95 percent of all breast cancers and
is the most reliable method to detect breast cancer.
The American Cancer Society recommends:
First mammogram by age 40
Mammogram every one to two years between ages 40 and 50
Annual mammogram after age 50
KEYWORDS: BREAST CANCER MAMMOGRAM