Breast Cancer Survival Guide, Part 1

The Screening-Test Shortage

Mammograms save lives; there's no doubt about that. When screening rates among women over 40 almost doubled from 39 to 70 percent between 1987 and 2000, the jump was linked to an estimated 5,000 fewer breast cancer deaths per year. Once doctors got today's two newer weapons in the screening arsenal -- digital mammography, a more-sensitive technology that's especially helpful for younger women and those with dense breasts, and breast MRIs, which find even tinier cancers at their earliest and most-treatable stages in women at high risk -- the expectation was that the death toll from breast cancer might drop even lower.

But alarmingly, that may not be the case. The remarkable lifesaving tool that is mammography is being undermined, for a number of disturbing reasons. Imaging centers, under financial pressure, are closing in record numbers. Those that are still in business have been slow to adopt the newer, higher-tech tests. Fewer doctors are choosing to specialize in breast imaging. And all this is happening at the very time when the number of American women who should be getting these screenings (those ages 40 to 84) is expected to grow, from 64.6 million to 77.4 million over the next 20 years. The numbers tell the story: Since 2001 the number of certified facilities offering mammography has dropped 5 percent, from 9,306 to 8,810. Because of the trouble involved, some women may fail to get regular screenings.

"Most women don't want to have to wait or travel for a screening test," says Etta D. Pisano, MD, Kenan Professor of Radiology and Biomedical Engineering at the University of North Carolina at Chapel Hill. A troubling new study in the journal Cancer suggests this may in fact already be happening. The proportion of women getting breast x-rays at least every two years actually dropped 4 percent between 2000 and 2005, which could translate into higher mortality rates. The decline was especially steep -- 6.8 percent -- among women 50 to 64, the group most likely to benefit, and women with higher incomes ($99,030 for a family of four with two dependent children).

"Missing even a yearly scan could mean that cancer, if it exists, may be discovered at a later, less-treatable stage," says Stephen A. Feig, MD, a professor of radiology at the University of California, Irvine School of Medicine. "This is especially risky for women in their 40s because their breast cancer can grow so fast." If you're one of the 23.3 million women over 40 who haven't had a mammogram in the last two years, pay special attention to the following.