Conflicting messages confusing women
Education on mammograms needed to dispel myths
Do you, or don’t you? The issue of mammograms and their effectiveness as a cancer screening process for women in their 40s made headlines this spring when the American Cancer Society (ACS) announced a change in its recommendations. Rather than annually if at high risk or once every other year if at average risk, the ACS now recommends women in the 40-49 age group have a mammogram yearly no matter their risk factors. The decision immediately put the organization at odds with the National Cancer Institute (NCI), which left the decision up to women in that age group, recommending they evaluate their own risk and benefit of having a mammogram.
Following a brief flurry of controversy, the NCI convened its board and amended its recommendations to be more in line with the ACS, recommending women age 40-49 have mammograms every one to two years. They agreed to work with the ACS to provide clear guidance to women concerning the risk of developing breast cancer and the value and limitations of mammography. But the recommendations still can be confusing since many of the major cancer medical centers across the country have established their own guidelines. City of Hope National Medical Center in Duarte, CA, recommends a mammogram every one to two years for women in their 40s depending on their risk. M.D. Anderson Cancer Center in Houston encourages annual mammograms for women ages 40-49.
Meanwhile, women in their early 30s are visiting the mobile mammogram units from M.D. Anderson, asking to be screened. "They are overestimating their risk," says Pat Cisek, MS, RN, CS, manager of Life Cheq cancer prevention program at the center. M.D. Anderson uses the 10-year rule. If a woman’s mother or sister had breast cancer at 42, then they will give her a mammogram at age 32.
So what should a woman do?
Education is needed so women can make informed health care decisions, patient educators say. "Today, everyone needs to learn how to advocate for themselves and to do that, they need information," says Marilyn Rhodes, RN, BSN, OCN, oncology resource nurse at the City of Hope National Medical Center. She suggests patient education managers teach women the following:
• How to determine individual risk for breast cancer.
First, women need to understand that although women have a one in eight chance of developing breast cancer, that risk is for a lifetime. "You have to live to be 90 before you become a one in eight person. The statistics are confusing, and they upset women," says Rhodes.
It is vital that each woman know her family history. She should ask questions and know the reason her grandmothers, aunts, sisters, and mother died. If they died from breast or ovarian cancer, there could be a gene that runs in the family and puts her at higher risk for breast cancer, says Rhodes.
The National Cancer Advisory Board in Bethesda, MD, defines women at higher risk for breast cancer as:
those with breast disease that may predispose them to cancer or those having had two or more breast biopsies for benign disease;
women with 75% or more dense breast tissue on previous mammograms that made mammography reading difficult;
women having a first birth at age 30 or older;
women who have had breast cancer;
women carrying identified genetic alterations that may make them more susceptible;
women in families in which multiple family members are affected with breast cancer, generally at younger ages.
• To establish a long-term relationship with a doctor.
It’s important for women to find a physician and establish a long-term relationship so the doctor will become familiar with her medical history. If a physician knows a woman’s health history, he or she can make better assessments and recommendations, says Rhodes.
• To have mammograms done at the same facility.
It’s a good policy for women to have their mammograms at the same facility each time so the techniques are the same, the machines are the same, and the same radiologist can review the X-ray and compare it to the last one, says Rhodes. If a woman moves all around, there is nothing to compare the mammogram with, she says.
• What to do if she wants a yearly mammogram and insurance won’t pay.
Many health care facilities have mobile units equipped for mammography that travel to health fairs and senior centers. City of Hope has a low cost mammography program. For $65 a woman can have a mammogram as long as she has a family physician where the radiologist can send the report. "If a woman tells me she can’t afford it, I tell her to be creative and have her children give her a mammogram for her birthday," says Rhodes.
• To make sure they have a baseline for comparing mammograms.
In her late 30s, or at least when she reaches age 40, a woman should have a mammogram to develop a baseline for future comparison.
• That a mammogram is only one method for early detection.
Women should not only have a mammogram but also a clinical exam by a physician or nurse practitioner and learn how to do breast self examination.
Another part of the education process should be to dispel any fear women have of getting a mammogram, says Kristina Pavlou, director of public education for Y-ME, a national breast cancer organization based in Chicago. "Some people think it causes breast cancer because of the radiation exposure of the mammogram," she says. Studies show that it does not increase a person’s risk.
Women also need to know how to correctly examine their breasts. Pavlou conducts classes throughout Chicago where she shows women a video on breast self exam and distributes pamphlets for them to take home.
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