October is Breast Cancer Awareness Month
Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office
October 2005 - October is Breast Cancer Awareness Month, and October 21st is National Mammography Day. Breast cancer is the second most commonly diagnosed cancer among American women, after skin cancer. Breast cancer is also the second leading cause of cancer death among American women, after lung cancer. The American Cancer Society estimates that in 2005, 211,240 women will be diagnosed with invasive breast cancer, and 40,410 will lose their lives to the disease. Men may develop breast cancer, however the numbers are quite low.
Breast cancer is the second leading cause of cancer death among American Indian and Alaska Native women. Lack of physical activity, alcohol consumption, and obesity, health risks often found in the AI/AN community, have been linked to increased risk of breast cancer.
Early detection of breast cancer increases the number of treatment options, improves the chance of successful treatment, and raises survival rates.
Monthly self breast exams and clinical breast examinations every three years between the ages of 20-40 are the recommended screening methods. Mammography and yearly clinical breast exams are recommended for those over age 40.
Mammography detects an average of 90% of breast cancers in women without symptoms. Through mammography, breast cancer can be detected at its earliest, most treatable stage, an average of 1/4 years before a woman can feel a lump. Mammography also locates cancers too small to be felt during a clinical breast examination.
American Indian and Alaska Native women have significantly lower rates of mammography screening than other races. In FY 2004, the Indian Health Service had a national mammogram screening rate of 40%. The California Area reported a slightly higher mammogram screening rate of 41%.The IHS goal for the mammogram screening rate is 70% of all eligible female patients age 52 and over. This target is based on the Healthy People 2010 goal of increasing to 70% the proportion of women aged 40 and older who have received a mammogram within the past two years. The IHS has made progress toward this goal, but much work remains to be done.
Low screening rates often result in poorer outcomes for AI/AN women diagnosed with breast cancer. While the incidence of breast cancer among AI/AN women is lower than other racial or ethnic groups, AI/AN women diagnosed with breast cancer have lower five-year survival rates in comparison to most other groups, mainly because their cancers are less likely to be found in earlier stages. However, one study concluded that the death rate from breast cancer could be reduced by more than 30% in American Indian women if current recommendations for biennial (every two years) screening were followed. Increased screening will result in earlier diagnosis and improved survival for AI/AN women with breast cancer.
Studies of mammography use have indicated that a physician referral or recommendation is one of the most significant factors affecting whether a woman gets a regular mammogram. Women may also forget to schedule a repeat mammogram, or may not understand the importance of regular mammography screening. Clinics should ensure that eligible patients are getting physician referrals and reminders.
There are programs available to help eligible, low-income women receive a mammogram. In California, the Cancer Detection Program "Every Woman Counts" can assist women whose incomes are at or below 200 percent of the federal poverty level. Information on this program can be found at: http://www.dhs.ca.gov/cancerdetection/ . (This program also assists eligible women in obtaining a Pap screening.)