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Prevent breast cancer deaths.


The next time you are in a room full of women, consider that every 11th one there will get breast cancer. If you are a female over 50 and you aren't getting a yearly mammogram, you're playing a kind of Russian roulette--because chances of five-year survival are far greater if a breast cancer is discovered by a routine mammograph. Caught early, breast cancer no longer means breast removal. Lumpectomy (lump removal) is a good option.

Betty Ford, Happy Rockefeller, Shirley Temple Black, and many other women like them are living proof that there is life after breast cancer. They are the fortunate ones, and your chances of being counted among the fortunate are much better if you go for your first mammogram once you've reached the age of 35 or 40. For most types of breast cancer the five-year survival rate is more than 85 percent for cancers discovered while in Stage I, and less than 35 percent for cancers not diagnosed until Stage IV.

Small breast tumors can be seen by X-ray long before they can be felt by any human hands. Self examinations are important, as are breast examinations by the physician. In breasts of C and D cup bra size, however, it is almost impossible to detect, by physical examination, a small tumor growing deep within.

I called Dr. Thomas Burchum, who has a fine reputation in radiology, to ask why more women aren't taking advantage of mammography in Iowa.

"There is no question that mammography is the best way to detect neoplasms of the breast before they can be felt,' he said. "In large breasts it is almost impossible to palpate a growing cancer before it is large enough to have spread. I think it's a matter of education; we need to educate the public.'

"To do that, wouldn't it be great,' I suggested, "if Dolly Parton would come out and say, "Breasts like mine need mammography'?'

Dr. Burchum laughed and said, "It would be great because you'll never feel a tumor in there. Along that line, we're in the process of equipping a van with a mobile mammography unit to go around to some of the smaller hospitals in the state to offer mammography. I don't think there is another such program in Iowa at this time. We'll bring mammography to women by letting them know that the unit is going to be at their local hospital on a certain day. We'll be working with local doctors and hospitals in the small towns.'

I asked him if this portable unit would also be the low-dosage radiation. "Yes,' he said. "We have a brand-new machine, made by Philips in Germany, that we think is the best unit on the market. It is "dedicated' just for mammography, and we use high-speed screens and films that are giving the absolute minimum in rads--less than 1 rad per breast.

"We're getting a van, much like one we saw in operation out at a hospital in Lincoln, Nebraska. It's very nice. The technicians can get the equipment in and out of the van by themselves with a lift. We find that it's best not to process the mammograms at the local hospitals where they're done, because of the variation in chemicals. We'll bring all the films home at night and run them on our own equipment. Just the technicians will go on the road, although I do go out to speak to local groups, to meet them, and on an eyeball-to-eyeball basis, tell them how important mammography is.'

What with the farm foreclosures and hard times for Iowa farmers, I asked him what it costs for mammography. Where does Iowa rank in cost for mammography that nationally can vary from $50 to $250?

"We charge $65,' he said. "We wanted to be on the low side, and we're very well satisfied with this. We don't think that it's necessary to raise the fee. In fact, if the volume increases, we may even go lower.'

When a needed procedure like this is obviously good protection, why don't more women go for it? I asked Dr. Pat Harper, who operates a busy breast clinic in Indianapolis. She handed me a report that paralleled the information obtained in The Saturday Evening Post survey: The most common reason for women not having had their mammographic examinations is their physician's failure to recommend the procedure. The report appeared in the July/August 1985 Ca-A Cancer Journal for Clinicians. The authors of the article sought to find out why doctors were not referring their patients for mammography. At first they surveyed the physicians to determine how many tried to follow the American Cancer Society's (ACS) recommendations in guiding their patients to these services. Of all physicians surveyed, only 11 percent reported that they followed the ACS guidelines with all patients. The family practitioners and internists were even less diligent, with only 9 percent following the guidelines. The gynecologists whose practices are dedicated to the care of women did not look much better, as only 17 percent of them follow or exceed ACS recommendations.

Of the surveyed doctors, 95 percent reported that they agreed completely with the ACS regarding the routine breast examination as an important part of a physical exam. Only 41 percent, however, reported that they agreed completely with the ACS regarding mammography. Of those who do not completely agree with the ACS on mammography, several reasons were listed:

Too expensive 39%

Not necessary without symptoms 29%

Too much radiation exposure 25%

Low yield 16%

If no family history, not necessary 14%

Patient won't cooperate 5%

Recommend self examination 5%

Only if patient has large breasts 3%

Test not reliable 3%

Should begin at earlier age 3%

Much concern has been voiced regarding the radiation exposure of annual mammography. Actually, the amount of radiation currently used to perform this test is very small. It would be about the same risk as smoking three-fourths of one cigarette. (How foolish it is for a woman who smokes several cigarettes a day to be concerned about the risk of the small amount of radiation needed for her breast exam.) Or compare it to the risk of traveling 400 miles in a commercial aircraft; or driving 60 miles in an auto; or 1 1/2 minutes of mountain climbing; or 20 minutes of life for a 60-year-old.

The American Cancer Society's position on radiation and mammography, as stated in its most recent official statement of mammography (June 1983), is as follows: "Available information suggests that the risk of inducing breast cancer by the low doses now possible with modern mammography--if it exists at all--is minimal. Because of the detection of some unpalpable and small breast cancers and because of the reduced radiation exposures now possible with optimum mammographic technique and carefully monitored equipment, a favorable benefit/risk ratio can be expected in women beginning at age 40 or older.'

What can be done about the problem? Simply this: All women need to be made aware of the importance of this examination. Then they will not be shy about asking their physicians to arrange for mammography if the doctor does not first suggest the test.

Diet and Breast Cancer Prevention

What causes breast cancer? The highest incidence of deaths from breast cancer is found in the most highly developed countries, those in which people's diets tend to be high in fats and low in fiber.

The National Cancer Institute has been carrying out a study to determine the extent to which diet is a risk factor in breast cancer. "The evidence associating dietary fat with certain specific types of cancer is really quite strong at this point,' according to cancer prevention researcher Dr. William DWys.

In the five-year NCI study, now in its second year, researchers are using a group of women subjects at high risk for breast cancer: those who have had previous biopsies for benign disease of the breast, those whose first-degree relatives have been diagnosed with breast cancer, and those who had a late-age pregnancy (after age 30). Half the women are asked to go on a low-fat diet and the other half are asked simply to continue their usual diet, which in the United States means about 40 percent of calories from fat. The other group will try to achieve a 20-percent-fat diet. The two groups will then be compared, over time, for cancer incidence.

"I think it's helpful to think about what are the major sources of fat in the U.S. diet and what strategies can be used to reduce these sources of fat,' said Dr. DeWys. "The three main categories of foods richest in fat include the meats, dairy products, and what we call fats and oils.

"The fats-and-oils category is probably the largest surce of fat,' he continued. "In many ways it is the one that can be adjusted with the least adverse effect on your overall diet.' This category includes butter and margarine used on sandwiches, salad dressings, and oil used in baking. "These foods people can readily give up without losing important nutrients,' Dr. DeWys said.

Next in importance is meats. The NCI suggests leaning toward fish and poultry and away from beef and pork. Meat could be cooked on a rack so that fats will drain off and not be consumed. Frying is definitely discouraged.

"Fortunately the meat industy is coming to our help in that they are making available low-fat prepared foods,' said Dr. DeWys. "Unfortunately we don't have a low-fat hot dog. But that's not the fault of the meat producers. In part it's 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.'

Traditionally, in Japan, only 20 percent of the calories in the daily diet comes from fat versus 40 percent of calories from fat in the United States. Note the chart on page 67 that shows the rate of deaths from breast cancer in Japan to be very low. (Men may be interested to know that the death rate from prostate cancer is also very low in Japan.) This chart, however, was compiled in 1976. It is interesting that the incidence of breast cancer in Japan has increased 250 percent since 1966. During this period many Japanese have shifted to a higher-fat, "Western' type of diet. Within Japan, the risk of developing breast cancer has been found to be 8.5 times higher among wealthier women who eat meat daily than among poorer women. A similar increase in breast cancer was found in Iceland, where the national diet has shifted from predominantly fish and sheep to more "Western' fare.

Just how does fat increase the risk of breast cancer? Experimenters postulate this happens in a number of ways. They believe fat encourages the development of certain hormones and serves as a vehicle for fat-soluble environmental carcinogens. The fact that Japanese women who migrate to the United States do not have an increased incidence of breast cancer until the second generation suggests that patterns of hormone metabolism in the early years of life many be determinants of breast cancer risk.

Almost anything a woman ingests can be detected in fluids secreted within the breast ducts. Five minutes after a woman smokes, for example, nicotine appears in her breast secretions. Breast fluids have much higher concentrations of cholesterol than the blood, and may also contain certain potential cancer-causing by-products of cholesterol metabolism.

Every time you go for that extra pat of butter, just think, "What if I become one of the 38,400 breast cancer fatalities this year?' Then imagine your dear husband's new wife going through your earthly possessions. Or perhaps you already have a better way to fight off the temptation of high-fat foods.

Photo: Betty Ford, Happy Rockefeller, and Shirley Temple Black are living proof that there can be life after breast cancer. The chances of surviving breast cancer are far better for the woman who is fortunate enough to have hers discovered on a routine mammography exam.

Photo: We hope Dolly Parton will never become a breast cancer victim. She is the celebrity we'd most like to recruit to help alert women of the need for mammography. In generous-sized breasts it's impossible to find tiny lumps manually.

Photo: Rita McFarland, an X-ray technician, demonstrates "dedicated' mammography equipment, which means the unit takes only breast X-rays. It has a small focus area, a compressing device, and it gives more detail while-delivering less radiation.

Photo: Radiologist Pat Harper operates a busy breast clinic in Indianapolis, where she does research on the use of ultrasound (above), for detection of fibrocystic breast disease. She does routine breast screening with state-of-the-art mammography equipment (below).

Photo: A) Normal Breast--The glands of the breast are arranged like the spokes of a wheel, with their ducts joining at the nipple "hub.' These are covered by variable amounts of fat. The cordlike glands can be felt in breasts with little fat. B) Cystic Breast--The "blue dome' cyst appears abruptly in a previously normal breast, and on palpation a movable, rounded mass is felt. Many women find they have no more fibrocystic breast disease after giving up caffeine.

Photo: C) Infiltrating Carcinoma--This malignant tumor has a hard, irregular feeling, and there is a restricted mobility of the mass. The tumor is white, with tiny, stretched threads of scarlike tissue running randomly throughout. D) External Signs--A breast tumor growing beneath the skin surface will often cause a dimpling. The skin may resemble an orange peel, which suggests that detection of the tumor has been dangerously delayed.
COPYRIGHT 1986 Saturday Evening Post Society
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Mar 1, 1986
Previous Article:Report on the Post's cancer prevention survey.
Next Article:Warming up in chili weather.

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