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HEATH HORIZONS : MEDICINE : Mammography--Vital but Not Foolproof : IT IS THE ONLY TECHNOLOGY CAPABLE OF FINDING BREAST CANCER IN ITS EARLY STAGES, WHEN THE CURE RATE IS 91%. BUT THERE ARE INHERENT LIMITS, ESPECIALLY FOR WOMEN UNDER 50.

March 29, 1992|KATHLEEN KELLEHER | Kelleher is a free - lance writer in Los Angeles. and

Mammogram quality is not the only problem in detection, however. The prospect of breast cancer is still so frightening that many women hesitate to get a mammogram. As Pasadena technician Brenda Miller puts it: "There is a lot of fear and anxiety over the exam and, of course, there is a lot of anxiety over the possibility of the outcome. We get women in their 70s, 80s and even 90s who have never had mammograms, mainly because their doctors never told them to get one. I do think women need to ask more questions. They leave it all up to their doctors. They don't do it till their doctors prescribe it."

Figures from the National Cancer Institute support Miller's assertions. Two-thirds of women over 40 have never had a mammogram, and a 1987 study found that the reason most often given by women for not getting them was "no need" and "lack of physician referral." Some mammography proponents and radiologists say that doctors need education about how to use mammography as much as the women they are supposed to be serving.

Women can dissipate some of the fear surrounding mammography by arming themselves with knowledge.

Although the benefits of mammograms are undeniable, a sobering government study released in December found that women are 25% more likely to get breast cancer than they were 20 years ago, and that more women are surviving because of early detection. The rise in cancer was almost entirely in women over 50.

Dr. Susan Love, director of the Faulkner Breast Center in Boston and author of "Dr. Susan Love's Breast Book," a book about breast cancer, mammography, chemotherapy and breast feeding, testified at a congressional subcommittee hearing on the findings.

"Maybe we are making some progress," Love said. "We have improved the quality of women's lives with less disfiguring lumpectomies (a surgical process that removes only cancerous breast tissue and some surrounding tissue) and chemotherapy and added years to their lives. But in terms of curing the disease, we haven't found the answer.

"The best we have is mammography. And mammography is not going to work for everyone, but mammograms in women over 50, where they work the best, have improved the cure rate by 30%. That 30% is important."

While efforts to encourage more women to get mammographies will be too late to help those who are victims of poor care, such as Stupp, there is a good chance that more women's lives will be saved by mammography, as Green's was--if quality control of mammography facilities is stridently enforced and the awareness of women continues to be raised about the technology and what they can expect from it.

Stupp says she felt stupid doubting her doctors and questioning the mammograms' reports, even though she could feel a lump in her breast.

"What happened to me is immoral," Stupp said. "Women just are not pushy enough to say, 'I am not satisfied with this,' when their doctors are saying, 'It's OK.' They need to take charge of their own medical health. What all of this does is make me realize how vulnerable I was when it came to those readings."

How to do Breast Self-Examination

Monthly breast self-examinations (BSE) save thousands of lives each year. Women should begin doing monthly BSE's at age 20.

If you menstruate, the best time to do a self-examination is two or three days after your period ends, when your breast is least likely to be tender or swollen. If you no longer menstruate, pick a day, such as the first day of the month, to do BSE. Familiarity with your breasts makes it easier to notice any changes, which should be reported to your physician.

BEFORE A MIRROR

A) Look at your breasts with your arms at your sides, then with your hands clasped behind your head and pressed forward. Sometimes lumps that are difficult to feel are easy to see. Look for any changes in either breast, a swelling, dimpling of skin, changes in the nipple or scaling of the skin.

B) Now press your hands firmly on your hips and bow slightly toward your mirror, as you pull your shoulders and elbows forward, looking at your breasts again. Do you see any significant difference between them?

LYING DOWN

These are some variations in BSE methods. The following represents the circular method.

1) Place a pillow or folded towel under your right shoulder and put your right hand behind your head. This position flattens the breast, making it easier to examine your breast thoroughly for any unusual lump or mass.

2) Now make the same small, circular motions with the flattened fingers of your left hand described earlier (in the shower section), circling your right breast. Start in the middle of your right breast, carry the motion through your armpit and down the sides of your rib cage. Check the top outermost part of your breast, and work your way completely around until you have examined it all. Circle at least three more times.

* Gently squeeze the nipple and look for any discharge. This could signal a problem.

* Repeat these same motions on your left breast using your right hand.

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