IN YOUR 40S? GET A MAMMOGRAM : ACTIVISTS PRAISE GOVERNMENT DECISION TO SUPPORT BREAST-CANCER SCREENING.

Byline: Jenifer Hanrahan Daily News Staff Writer

Almost 50 years ago, a gal named Terese Lasser had her breast removed. A painful mastectomy shaved her chest muscles down to her ribs. The missing flesh threw off her balance.

Before the days of reconstructive surgery, Lasser did the only thing she could do, recalled her friend, Helene Brown.

``She went into the department store to get a bra to stuff with something,'' said Brown, an honorary lifetime member of the America Cancer Society's National Board of Directors. ``And they kicked her out. They said, `We don't allow people like you to try on underwear.' ''

When Brown began promoting women's health issues 47 years ago as a volunteer for the Cancer Society, her job was to spread the word about Pap smears and self-breast examination.

In those days, the only breast cancer screening available to most women was feeling a lump.

Oh, how times have changed.

Last week, the federal government came out in favor of mammograms every one or two years for women in their 40s.

``It's marvelous, absolutely marvelous,'' said Brown, a longtime Sherman Oaks resident. ``Women will make decisions for themselves, but they need guidance.''

Health-care victory

The announcement by the National Cancer Advisory Board on the controversial mammogram debate was a significant victory for the grass-roots campaign to improve women's health care in the United States through legislation, gender-specific research, increased funding and improved standards of care.

Across the country, women in the breast-cancer prevention movement started support groups and outreach programs to encourage women to get regular exams. They even took their message on the road with the Wall of Hope, a traveling photo exhibit celebrating breast cancer survivors, and adopted the pink ribbon, a variation on the red AIDS ribbon, as a symbol to increase awareness.

``For a long time, it had been a subject that people didn't discuss,'' Brown said. ``It turned out that a lot of women not only wanted to talk but wanted to do something.''

The move by the cancer advisory board, which advises the National Cancer Institute, is expected to put pressure on the insurance industry to pay for mammograms. The Cancer Institute's decisions are used by health insurance companies to set benefits and by doctors to determine appropriate care.

``This is a big deal,'' said Linda Hirsh, a member of the Los Angeles Breast Cancer Alliance, a group that lobbies for improved health care for women. ``Before, women were left in a bind.''

A helping hand

Kay Powell, founder of Los Angeles-based Sisters Breast Cancer Survivor Network, a group that provides information and support for minority women who have been diagnosed with breast cancer, said she believes the decision will make it easier for low-income women to have mammograms.

``So many times, I hear the excuse that they don't have the money,'' Powell said. ``We're going to go out and spread the word and let the ladies know money won't stop them.''

For women at high risk of breast cancer, the recommendation advises seeking expert medical advice about mammograms before age 40. High risk factors include a family history of breast cancer and delaying pregnancy until after age 30.

For decades, women have gotten conflicting information about whether to have a mammogram. In 1977, the National Cancer Institute and the American Cancer Society issued the first guidelines, recommending that women 40 to 49 have mammograms only if they or their mothers or sisters had breast cancer.

In 1980, the Cancer Society recommended a one-time mammogram for women 35 to 40 to establish a base line for future measurements, with women younger than 50 consulting their doctors to decide whether to have one.

In 1983, the Cancer Society told women from 40 to 49 to have mammograms every one to two years.

Muddling matters furt`her, the National Cancer Institute in 1993 said there was insufficient evidence to justify mammograms for women in their 40s.

Calling for clarification

So when a panel of experts assembled by the National Cancer Institute convened in January to hear two days of evidence from specialists and researchers, women's health advocates were hoping for clarification.

Instead, the panel said each woman should ``decide for herself.''

The debate over mammograms for younger women revolves around the high number of false alarms and questions about whether the mammograms save lives.

Mammograms are far from a foolproof method of detecting the cancer, especially in younger women, because their breast tissue is more dense. Mammograms miss about one-fourth of invasive breast cancer in women in their 40s, compared to one-tenth of such cancers in women 50 and older.

Because of this, mammograms for women younger than 40 are not a ``panacea,'' said Dr. Mitzi Crockover, director of the Iris Cantor-UCLA Women's Health Center. ``Mammograms are not going to catch all the cancers in 40-year-olds. What we need are better ways of screening.''

About 1.5 percent of American women will get breast cancer between age 40 and 49.

An important procedure

Almost all health professionals agree that women past 50 should get annual mammograms that can spot tumors before they spread to other organs and can reduce breast cancer deaths by 30 percent. Most also agree that mammograms are generally unnecessary for women in their 30s.

Traditionally, governmental and medical advisory bodies' decisions to recommend screening for disease are based only on scientific evidence and cost-effectiveness. In other words, will testing people for the disease save enough lives to make economic sense?

The breast cancer issue, and questions of women's health in general, have moved beyond the scientific world and into the political realm.

More than any other disease, American women fear breast cancer, said Dr. Debra `Judelson, president of the American Medical Women's Association, a group of women doctors and medical students that was formed in 1915 when the American Medical Association was closed to women.

The disease's impact on women cannot be fully measured by scientific studies or medical bills, Judelson said.

By recommending that women get mammograms if they are in their 40s, ``it says it's worthwhile to save lives,'' Judelson said. ``Even if the technique isn't perfect, we are going to the trouble and expense necessary to catch a disease in its early, treatable stages.''

Despite any evidence to the contrary, Joanne Eacrett of Woodland Hills, is more than certain that mammograms save lives.

At 47, a mammogram spotted cancer that she had removed by a mastectomy.

``I know there are many different opinions,'' said Eacrett, 55, who has been active in the Breast Cancer Alliance. ``I know that other people feel it doesn't save lives, however, I feel that I am here because of it.''

CAPTION(S):

Drawing, Photo

Drawing: PINK POWER

Women win a battle in the war against breast cancer

Bradford Mar/Daily News

Photo: ``It's marvelous, absolutely marvelous. Women will make decisions for themselves, but they need guidance,'' the American Cancer Society's Helene Brown says of the mammogram decision.

David Sprague/Daily News