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The mammobile goes to Washington.

The Mammobile Goes To Washington

A patient who had a mammogram on the Mammobile had listed no physician. She wanted to be notified of the results herself. When the radiologist called me with the findings, I was left with the unpleasant duty of telling this lady that she had a suspicious density in her breast that should have immediate attention. She told me she didn't know any doctors and asked for the name of mine. I gave her two good references, but she persisted, "Which one do you use?' I then gave her the name of my own doctor and she seemed satisfied. "That's where I'll go,' she said resolutely. From our conversation I learned that if our Mammobile hadn't been parked behind the Indianapolis Federal Building, where she worked, she wouldn't have gone for a mammogram and wouldn't have known about the suspicious density until she could feel the lump. I could only pray that it wasn't already too late for her.

My thoughts went to the time breast cancer hit home in our family and it was too late. When my brother, a rear admiral in the U.S. Navy, called to say his wife Elaine had found a lump in her breast, I flew to the National Naval Medical Center in Bethesda, Maryland, with hopes that it would be small. The larger the lump, the more likely the cancer has had time to spread. Surely Bethesda hospital patients would have the best care in the nation. Surely Elaine wouldn't be coming in with advanced cancer. She was educated, well read, a conscientious and tireless worker for her family and church. As the wife of a rear admiral she had an active social life. But surely she would have been getting regular checkups and mammography.

For Elaine, however, it was too late. My heart sank when I felt that horrid, large hardness in her breast. She had found the mass--she had never had a mammogram. The next day we waited anxiously to get the pathologist's report to learn whether cancer had spread to the lymph nodes. Positive lymph nodes would lower her chances for five-year survival from 91 to 59 percent.

My brother tried to be cheerful and to appear optimistic: "Only three positive nodes out of 19.' He spoke assuredly, as though he were in complete control of the problem. Like an admiral in charge, he set about to fight the war against breast cancer. Small victories were celebrated: no bone involvement could be found; the hope for a new chemotherapy that just might arrest the spreading demon. He sent airline tickets to their children in distant cities so that they could visit their mother often. He stayed home to be with her. Women are permitted to cry at weddings, but when Elaine cried as our daughter gaily flung her bouquet before departing for her honeymoon, we all were aware that she was crying because she knew she wouldn't live long enough to plan her own daughters' weddings. She died soon after.

Our Society supporters know that the Mammobile started in Indianapolis and has been winding its way eastward. We had no particular reason for going east instead of west, because goodness knows we have had enough requests to go west.

In Cincinnati, we knew we had a great colleague in Dr. Myron Moskowitz, professor of radiology at the University of Cincinnati. This dedicated man is saving women's lives right and left in his research projects with the National Cancer Institute (NCI). Traveling around the country, he lectures to fellow mammographers, radiologists, and primary-care physicians. His mission is to educate the public as well as the doctors about the latest technology in low-dose dedicated mammography.

He heads one of three centers where the NCI research program is identifying women at high risk for breast cancer. These women are asked to go on a special diet that includes a reduction to 20 percent of dietary calories provided by fat instead of the average American diet of 40 percent fat. This is of special interest to the Post because we would like to encourage the high-risk women who come to the Mammobile to go on the breast-cancer-prevention diet.

The University of Cincinnati received us graciously, and we believe that as a result of our Mammogram Awareness Week there, they soon will be given a mobile unit of their own by a large local donor.

The Mammobile then went on to Virginia Beach, Virginia, where it was so much in demand that we had a difficult time screening everyone in the week allotted to us. The Leigh Memorial Hospital helped sponsor the first week there by supplying mammography technologists.

Virginia Wentz, of Thomson-CGR, who had flown to Indianapolis to train our mammographic technologists, also came to Virginia Beach to make sure the technologists at Leigh Memorial were checked-out on the new Thomson-CGR, state-of-the-art, low-dose dedicated mammography equipment that we have on the Mammobile.

After discovering more breast abnormalities in Virginia Beach than we had expected, we stayed another week in order to screen everyone at CBN.

Danuta Soderman, co-host of the "700 Club,' was game to have her mammogram done on TV for her fans. She even let the audience know that a worrisome density had been found. Her fans were all relieved when she was able to report on a later broadcast that the densities seen on her mammogran needed only further monitoring in three to six months.

Dede Robertson was next. As it turned out, we were glad that the Mammobile was located in view of the chancellor's home on the campus of CBN University where Dede and Pat Robertson live. Dede had just flown in from Texas, where she had received the Christian Woman of the Year Award. With her fantastically busy schedule--looking after her family, traveling for her many volunteer responsibilities--it is easy to understand why she hadn't found time for a mammogram for too many years. She hurried over to the Mammobile to take care of this neglected personal matter. When her mammogram was read, it showed calcifications, and a lump was promptly removed. Further biopsies were done indicating diffuse dissemination of malignant cells necessitating a mastectomy. Dede's serenity in the face of breast cancer is beautiful to behold.

"I can't imagine how a woman can go through having a lumpectomy without knowing the Lord. When you know He is in control of the situation, it gives you peace of mind,' Dede told us in her usual happy, upbeat manner. We know that women with faith and a positive attitude always do better with this curious disease. We talked to Dede about how serious the women seem who sit in the Mammobile waiting for their mammogram. She suggested Psalm 91 might be framed in the waiting room of the Mammobile:

"We live within the shadow of the Almighty, sheltered by the God who is above all gods.

2This I declare, that he alone is my refuge, my place of safety; he is my God, and I am trusting him. 3For he rescues you from every trap, and protects you from the fatal plague. 4He will shield you with his wings! They will shelter you. His faithful promises are your armor. 5Now you don't need to be afraid of the dark any more, nor fear the dangers of the day; 6nor dread the plagues of darkness, nor disasters in the morning. . . .'

When I asked her for appropriate religious music that we might play on the van, she suggested praise hymns like "How Great Thou Art' and "To God Be The Glory.'

I'm thankful for having had the opportunity to spend a weekend with Dede right after she learned of the malignant cells. As a nurse, she knows exactly what to expect; as Christian Woman of the Year, she sat reading the Bible and then knitting as we flew to California. If her bandages were uncomfortable or if she were fearful of the impending further surgery, she never let it be known. She hostessed large crowds, welcoming her guests graciously.

Our Mammobile then headed for Washington, D.C. Dave Cialdella, who registers patients outside the van, also drives the van for our mammographic technologist, Sherry Ferguson. Rev. Peter Michael registers patients and also does TV documentaries for the Post wherever he goes. Bob Silvers, vice president of the Society, is administrator of the project which we hope will cause the death curve for breast cancer soon to make a sharp drop.

Our first location in Washington was at 12th and Constitution, where we worked with marvelous medical personnel at the IRS building and also at the Smithsonian. Dr. Mary Gamez is the physician in charge at the IRS building, and Dr. J. Andrew Armer, Chief of Health Services, is in charge at the Smithsonian. Joan J. Simms and Susan Little, area nurse supervisor from the Department of Public Health, helped immensely by alerting all their personnel and keeping the parking meters bagged and the Washington police ticket dispensers at bay. While there, we had far more women signing up than we could finish in a week. In fact, it soon became apparent that processing the applicants would take two weeks.

The next stop would be the Capitol, to mammogram women in the Senate and House office buildings.

We had operated the Mammobile at Senator Richard Lugar's Annual Fitness Fair in Indianapolis and we knew his office would be a good place to start our effort to mammogram the women of Capitol Hill. In no time at all Dan Heimbach in Senator Lugar's office helped us arrange everything with the Senate Sargeant of Arms. He even paved the way for us to go to the White House next. Congressmen Andy Jacobs and Dan Burton were marvelous help on the House side. They all helped pass out notices to Senate and House personnel and made arrangements for us to leave the vehicle overnight on the plaza.

Capt. William Narva is the newly appointed Capitol physician, and he readily understood what we're trying to accomplish. As a matter of fact, TV coverage of our press conference may have helped create a scheduling problem at Bethesda. He told us that the backlog of military personnel and dependents who are asking for mammograms at Bethesda has resulted in a 6- to 7-week wait. "Could we send 100 of our women down for their mammograms?' he asked after determining how many we could do in a day. We were happy to have his blessings on the important project on the Capitol plaza.

In the House of Representatives, Mary Rose Oakar's big beautiful brown eyes almost became tearful as she told of her mother's breast cancer. The disease ultimately took her mother's life, and Mary Rose's sister is also a victim of breast cancer. This Ohio congresswoman has done a great deal of research on breast cancer prevention and has facts to show that screening all women for breast cancer would be cost effective as it would save the hospitalization costs of treating many cases of advanced breast cancer.

Dr. Judith Bader spoke at the press conference at the National Press Club about the lumpectomy vs. the mastectomy program at the National Cancer Institute.

Any readers who find themselves faced with a breast lump and the need for therapy may call her to find out more about the opportunity to have a mastectomy with full breast reconstruction or to have lump removal and radiation treatment. After a patient has been accepted for the program, the NCI will pay for travel to and from Bethesda and for all follow-up treatment pertaining to the breast cancer. The patient agrees to be placed in whichever program the computer determines in this randomized study. Readers who would like more information about the NCI program can also obtain reprints of the SatEvePost articles describing it in detail.

Dr. Ritva Butrum of Finland is the acting director of the Diet and Cancer Department at the NCI. She honored us by coming down to speak at our press conference and also by having a mammogram then and there on our equipment. Dr. Butrum provided us with information about the study she is doing with Dr. Moskowitz and was pleased to know that he would read her mammogram.

Cincinnati, Houston, and Seattle are the cities where the NCI feasibility studies have begun.

Any of our members who live in or near these cities, who would like to be involved in the program, and who have the listed high-risk factors, can contact the following individuals about joining the research project.

* Maureen M. Henderson, M.D., Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104

* William Insull, Jr., M.D., Baylor College of Medicine, Houston, TX 77030

* Myron Moskowitz, M.D., University of Cincinnati College of Medicine, Cincinnati, OH 45221.

Women in these centers will be given an opportunity to participate in this early feasibility study. If all goes well, there will be an effort to obtain 30,000 women to participate in the program. Dr. Butrum is the acting director of the large study, having taken the place of Dr. William DeWys.

Women are given help in adjusting their diets from the average American diet of 40 percent of calories in fat to 20 percent of calories in fat. The women in the program will be those at high risk. Briefly, eligibility criteria include:

1. Women ages 45-69

2. Baseline percent calories from fat equal to or greater than 38 percent

3. At least one of the following:

* Two or more first-degree relatives (mother, sister, or daughter) with a history of breast cancer

* History of unilateral breast cancer in one first-degree relative

* History of benign breast disease (two or more surgical biopsies)

* Never been pregnant with first live birth over 30 years of age

* Single surgical biopsy with atypical epithelial hyperplasia.

Reasons for exclusion from the program include:

* Body weight more than 50 percent above ideal weight

* Medical conditions such as cancer, alcohol dependency, and lipid-lowering medications

* Refusal to sign consent form

* Not interested in trial participation, characterized as potentially unreliable or noncompliant

* Currently following a low-fat diet (less than 35 percent of calories from fat) or;

* Lacto-ovovegetarian diet;

* 50 percent or more of meals eaten outside the home.

The general strategy incorporates teaching nutrition skills, self-monitoring techniques, behavior-modification techniques, and group-support systems. Common protocols, data forms, educational materials, a nutritionist's manual and a participant's manual, and training workshops for nutritionists were conducted or developed to establish uniformity in methods and procedures for the intervention program.

Nutrition instruction and counseling will be conducted primarily in group sessions held weekly for the first eight weeks of intervention, followed by biweekly sessions throughout the remainder of the six-month intervention period for the feasibility study. Individual sessions are scheduled for developing an individualized low-fat eating plan and for a three-and six-month follow-up visit.

Serum cholesterol, determined at baseline and at six months on the intervention program, will be used to evaluate the effectiveness of this objective biochemical measure in monitoring adherence to the low-fat eating plan.

It is estimated that the study population of 30,000 women with a follow-up period of eight to ten years would be required to obtain a statistically reliable test of the hypothesis.

We believe there is already sufficient evidence for women who do not live near the test cities to start their own low-fat regimens. We have written a great deal about low-fat diet and how important it is in the prevention of breast cancer.

When we interviewed Dr. DeWys, formerly with the NCI, he said, "We are giving dietary fat particular emphasis in our studies. The types of cancer that have been associated with high intake of dietary fat include cancer of the breast, colon, prostate, and endometrium (lining of the uterus). We think that if we can reduce the dietary fat intake in the population, we can significantly reduce the incidence of these cancers. At present, I would say that the evidence is perhaps 99 percent certain of these associations that I've mentioned. We're in the process of conducting a research project which will, at least theoretically, bring us from 99 percent up to 100 percent certainty.

"I think it's helpful to consider what the major sources of fat in the U.S. diet are and what strategies can be used to reduce these sources. Currently, 40 percent of the calories in the U.S. diet are derived from fat. In our current research, we will aim for a diet with a 20 percent fat content,' Dr. DeWys said.

"The three main categories of foods that are richest in fat include the meats, dairy products, and what we call fats and oils. Often when people think of fat, they think of fat associated with meat, but may not think of the other two categories that I've mentioned. The fats and oils category is probably the largest source of fat in the U.S. diet, and in many ways is the one that can be adjusted with the least adverse effect on your overall diet. In the fats and oils category we include such things as butter and margarine that are used on sandwiches. We include salad dressings and oils used in baking. These are foods that people can readily give up without losing important nutrients.

"Recommendations that we would make to the general public in terms of reducing their fat intake will be to avoid or minimize their use of the foods in the fats and oil category. In the meat category, we have a series of suggestions that would be easily implemented to reduce the fat content drawn from meat. One suggestion is to make food choices in the direction of selecting more fish and poultry and making few choices from the redmeat category: beef and pork.

"We suggest that when people prepare their food, prior to any cooking, they remove all visible fat from beef or pork. And, if they are using poultry, they remove the skin, because in poultry much of the fat is associated with the skin.

"We believe that the cooking method is important, and we recommend cooking the meat on a rack so that any fat released by the cooking process can drip off and be discarded. We particularly discourage use of frying.

"The other thing to comment about in terms of food choices is that the fat on the outside of a food may be trimmed off and should not be a particular concern when one is purchasing meat. What one should look at when purchasing meat is the marbling, the fat distributed through the meat that can't be trimmed off and discarded. Selection should be based on finding meats with less marbling, and that way less fat would be retained in the meat after the the visible fat has been trimmed off. There has been a significant trend over the last years toward leaner pork being available. We laud that. That's a very important contribution that the meat industry is making toward the health of the population in this country.

"We still don't have a low-fat hot dog, and that is in part because of the rules of the Food & Drug Administration that require something called "the standard of identity'; for a food to be called a hot dog, it has to have a certain composition, and until they change the rule we will not have a low-fat hot dog.

"One of the nutrients that may be important in protecting against cancer is vitamin A. The vitamin A category of nutrients and the particular fruits and vegetables that are rich in vitamin A are those having a yellow or a dark green color. We recommend that people make several choices each day from the broad category. Foods such as squash, carrots, and tomatoes are from the yellow category. For the green category, choose broccoli, spinach, etc. These will provide more than adequate vitamin A in the diet. The evidence suggests that diets with a high intake of vitamin A may be protective against lung cancer, cancer of the mouth, larynx, and the esophagus.'

Research is currently in progress at many centers throughout the world focusing on the risk factors for breast cancer and on ways to lessen the likelihood of contracting this disease.

As the age of first pregnancy increases among American women, there is evidence that the risk of breast cancer may also be increasing. Multiple studies have shown an increase in breast cancer when the first pregnancy takes place after age 27. A study by the American College of Gynecology reported a four-fold increase in breast cancers in women who wait until 34 to have a first child.

Women who had not borne children were found to have 1.4 times the cancer risk of women who had children. The women who had their first child by age 20 had about half the risk of those who were childless.

Theories abound as to why this happens, but the mechanism remains poorly understood. One hypothesis suggests that a change in breast tissue may reduce the response to certain hormones; another, that there are permanent changes in the levels of hormones circulating in the blood.

Whatever the mechanism, there is evidence to suggest that it takes place during the first three months of pregnancy. Studies indicate that pregnancies aborted--either spontaneously or induced--in the first trimester do not have any protective effect and in fact may actually increase the cancer risk substantially. Abortion after the first pregnancy does not appear to have any effect on cancer rates.

The age that a woman begins menstruating is also a factor in breast cancer risks. Women who begin to menustrate before the age of 12 have a two-fold increase in their risks of breast cancer when compared with those who have onset at 13 or older.

Another factor is menopause. Women whose natural menopause occurs before 45 years of age have only one-half of the risk shown by those whose menopause occurs after age 55. Stated another way, women with 40 years or more of active menstruation have twice the cancer risk of those with less than 30 years activity.

Surgically induced menopause also seems to have an effect on risk of breast cancer. Indeed, removal of both ovaries or radiation treatment of the pelvic area may have an impact even greater than natural menopause.

Dr. Brian MacMahon and colleagues from the Harvard School of Public Health noted that surgically induced menopause lowered breast cancer risk to about 60 percent of the rate of women who had natural menopause between the ages of 45 and 54. Those who had surgery before age 35 had the greatest decrease.

Perhaps the most significant risk factor, and one of the more easily controlled, is weight. It appears to be especially important in postmenopausal women. In a study in Holland, women aged 60 to 69 weighing more than 155 lbs. had an 80 percent increase in breast cancer risk compared with women weighing less than 132 lbs.

Photo: The Mammobile did free mammograms for the Senate office buildings and then moved across the plaza to take women from the House of Representatives' office buildings.

Photo: The plague of breast cancer spares neither the rich nor the poor, neither black nor white. Women from every socioeconomic position suffer in what would appear to be an increasing incidence. Rich women have a slightly higher incidence than the poor. Obese women have a higher incidence than their thin sisters.

In Washington, the Mammobile explored sites at the Providence Baptist Church, with an inner-city congregation, and at the National Cathedral and the prestigious Saint Albans. We discovered women in both high and lowly social positions are failing to have mammograms as they should.

Photo: Virginia Wentz is the daughter of missionaries in Japan. She told us her mother is often asked to bring U.S. breast cancer patients back home. Mammography isn't done on these women in Japan and their cancers are often advanced before detection.

Photo: Dr. Moskowitz of the University of Cincinnati (left), who reads the mammograms, is surprised at the number of abnormal breasts discovered to date. The Mammobile spent its first out-of-town engagement at the Elm Street Clinic and at churches in inner-city Cincinnati.

Photo: Robert Silvers (right) helped us arrange the mammogram program at CBN, where Danuta Soderman gamely agreed to have her mammogram on camera for the 700 Club. Pat Robertson and Ben Kinchlow sent Dede and Vivian for mammograms.

Photo: Dede Robertson faces breast surgery with peace and optimism.

(Left) Just after hearing about the malignant cells, she accompanied her husband to the West Coast for the weekend. (Right) After reading Psalms 91, she knits for their first grandson, "Willie' Robertson.

Photo: Joan Simms (left), IRS Employee Relations Specialist, and Susan Little (center) helped us notify the women about the Mammobile program. Said Joan, "When the Male Mobile comes, we'll send out sealed notices on blue paper with "FOR MEN ONLY' stamped on the outside.'

Photo: Ellen Kingsley of Channel 9's Eyewitness News in Washington, D.C. (right), has done much to help other women catch their cancers early. She is being treated for breast cancer with positive lymph nodes. Area Nurse Supervisor Susan Little of the Department of Public Health discusses the Mammobile screening with her.

Photo: Ohio Congresswoman Mary Rose Oakar's beautiful brown eyes became tearful when she related the story of her "spunky little mother's' death from breast cancer.

Photo: David Cialdella registers patients outside the Mammobile while Sherry Ferguson does the mammograms inside.

Photo: Susan Glick, a reporter for the U.S. Information Agency, based in Washington, D.C., interviews a Mammobile patient. The report was broadcast to millions of viewers in Europe and military bases around the world on "America Today.'

Photo: The Mammobile explored the parking possibilities at the home offices of Dr. Otis Bowen, secretary of the Department of Health and Human Services.

Photo: Dr. Ritva Butrum, acting branch chief of diet and cancer, came from Finland to the NCI. She heads the program in which Dr. Myron Moskowitz is participating. She had a mammogram after meeting the press.

Photo: Dr. Judith Bader is the principal investigator for the NCI Early Breast Cancer Trial. She needs more patients to enter the Bethesda program. The Mammobile expects to supply these patients from the Washington, D.C., area.

Photo: Dr. Jean Elder is acting assistant secretary in the Office of Human Development Services of the Department of Health and Human Services. She gave greetings from Dr. Otis Bowen, secretary of HHS.

Photo: Post editors had a chance to tell Senator Gary Hart about the Mammobile project on Capitol Hill. He was pleased.
COPYRIGHT 1986 Saturday Evening Post Society
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Title Annotation:mobile cancer detection unit wends its way from Indianapolis to the capital city
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Oct 1, 1986
Words:4454
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