The recent frenzy of media attention concerning the breast screening procedure mammography is probably the most counter-productive women's health issue of recent memory. Mammograms have saved thousands upon thousands of lives since it was first offered in the 1960s. When we look at the annual death rate in Rhode Island from breast cancer from 1990 to 1998, we see a 1% drop each year. I would like to believe that the surgeons, medical oncologists, and radiation oncologists treating breast cancer are doing a better job, and indeed, they are. However, it is much more likely that the early detection of small cancers has made it easier for us to cure the disease.

It is the nature of cancer that early, small cancers are easy to cure. In the case of breast cancer, a 90 to 95% cure rate can be expected, while more advanced cancers, not only larger in size in the breast, but with a higher likelihood of positive lymph nodes in the axilla, may have, at best, a 50% chance of cure. Mammogram can detect a cancerous lesion the size of the head of a pin. At the earliest time a tumor can be palpated it may be approximately 1 cm. in size, about the size of your fingernail. A 1-cm. tumor contains over one billion cancer cells, some of which may have become extremely aggressive and more likely to spread beyond the breast.

The current controversy arose out of a publication by two Danish statisticians who re-examined the data from the nine clinical trials that have established the usefulness of mammography. They selected as the basis of their argument trials that other statisticians have seriously questioned and they discarded data from trials that other statisticians consider correct. These two Danish statisticians then claimed that data establishing the effectiveness of mammography to detect early cancer and contribute to an increase in women's cure rates from breast cancer just did not exist. Their argument has been rejected by the National Cancer Institute in Washington, and every major oncology society in America and abroad.

There is not doubt that new and more effective means of detecting breast cancer would be of great benefit, but until such a time that we have an established, acceptable alternative to mammography, women would be well advised to continue to have their mammograms on a regular basis and not play Russian roulette with their lives.

For more information and answers to specific questions contact the Rhode Island Cancer Council at Tel@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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