The 1980s and 1990s have witnessed a remarkable increase in
resources devoted to women's health and, in particular, the early
detection of breast cancer. These improvements have included:
expanded insurance coverage of screening mammography, new federal
funds earmarked specifically for breast cancer research, the
creation of new medical facilities designated as women's health
centers, the institution of federally mandated guidelines for
standardization and quality control of mammography facilities,
technical improvements in mammography, stereotactic breast biopsy
as an alternative to surgical biopsy, the development of new breast
imaging modalities, and improved awareness of women's health issues
through increased media exposure.
Despite the dramatic expansion of breast imaging services
available to women and the emphasis in the media on breast cancer
awareness, too many women continue to present for their initial
mammogram with advanced clinical disease. Two recent disturbing
examples from our breast service bring this to mind. The first, a
well-dressed 78-year-old woman with diabetes who was status-post
two cataract surgeries and a retinal laser within the year,
presented with a 15 cm ulcerating cancer of her left breast. She
stated that she had had a small bruise for some time and had come
in to be seen because it had begun to bleed. The second, a
63-year-old recently retired woman, was referred from her family
practitioner for an itching, inflamed right breast. Physical
examination at the time of her mammogram showed a markedly deformed
breast, with nipple retraction and numerous erythematous skin
nodules consistent with an advanced breast cancer. She could not
recall the date of her last mammogram. Her cheerful disposition at
the time of her visit reflected the depth of her denial.
Screening mammography has consistently enabled the detection of
significantly smaller and potentially curable breast cancers.
Although many advances have been made in services available and in
making the public aware of the fact that early detection of breast
cancer saves lives, the current system occasionally fails, as in
the two cases described above. These examples support the continued
need for educational programs and for patient-friendly medical
services. We must actively and enthusiastically emphasize the
positive aspects of screening mammography. We must tear down the
barriers that may prevent women from taking this all too important
step to ensure their own health and well-being.
Dr. Hogge is an Assistant Professor in the Breast Imaging
Section of Radiology at the Medical College of Virginia of Virginia
Commonwealth University, Richmond, VA.