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NY's Declining Mammography Rates Put Women At Risk The life-saving benefits of mammography are very well known, yet according to a new Center for Disease Control (CDC) report, 1.5 million fewer women took advantage of this test in 2005 as compared with 2000. This alarming decline is compounded by the fact that uninsured women are the least likely to get their annual mammograms as recommended by the American Cancer Society. "We have known for some time that mammography rates have been declining," said Eva Sciandra, Director, Cancer Detection Strategies for the American Cancer Society of NY and NJ. "This trend is very disturbing, and our Strike Force has been investigating the possible reasons behind the decline. But even as we are investigating the reasons, these cancers are growing and will be more difficult to treat when they are detected, usually when symptoms begin to show." These national figures are mirrored at the local level. In New York State, from 2000 - 2004, the most recent year data is available, women 40 and over having mammograms within the past two years fell from 80.6 percent in 2000, to 75.5 percent in 2004. The 5.1 percent decrease is substantially higher than the 1.8 percent drop reported by CDC. While the CDC report tracks women who reported having had a mammogram in the past two years, the American Cancer Society recommends that women get their mammograms annually. American Cancer Society screening guidelines say that women age 40 and above should be getting an annual mammogram, but the data show that the percentages of women who have had an annual mammogram are even lower. According to CDC Behavioral Risk Factor Surveillance System (BRFSS) survey data, the percent of women ages 40 and older who reported having had a mammogram within the past year declined between 2002 and 2004 slightly more than the nationwide rate in that period. Even more alarming is the fact that medically underserved and uninsured women are least likely to take advantage of mammograms. Access to care remains a critical reason that both men and women do not get screened for cancer. Lack of insurance is the number one barrier to getting screened - greater than income, ethnicity and education. Women without health insurance have even lower screening rates than their counterparts. In 2002, 42.7 percent of women in New York without health insurance had mammograms within the past year. In 2004 those rates had dropped dramatically to 35.8 percent in New York. Another disconcerting trend is shown in a recent study: annual mammography among breast cancer survivors, who are at increased risk of a recurrence or a new malignancy in the other breast, dropped off after a few years. During the five-year study period, one of three women in this high-risk population had not received regular annual mammograms. - more - TThere does not appear to be any single reason for the decline in screening mammography rates. It is likely that several factors are influencing the trend. Some that the American Cancer Society Mammography Strike Force is currently investigating include: +Mammography capacity - Is the number of mammography facilities and machines adequate to meet the current and projected need? Is the professional workforce adequate to perform and interpret mammograms based on current and projected need? Are there significant business and/or medical-legal issues that influence technical and workforce capacity? +Access - Are the public and private resources currently available adequate to provide mammography screening for all uninsured and medically underserved women? Are they being fully utilized? +Referrals - Are primary care and specialist practitioners systematically referring women ages 40 and older for annual mammography? +Public attitudes, beliefs, behavior - What are women's attitudes and beliefs about the efficacy of mammography, and are these beliefs influencing behavior? Mammography - its effectiveness, its benefits and risks, at what age women should be screened and how often - has been the subject of periodic public and scientific debate for at least three decades. The American Cancer Society, the National Cancer Institute, the US Preventive Services Task Force, and countless other medical, public health, and breast cancer advocacy organizations recommend regular mammography screening based primarily on the published evidence from international clinical trials. These trials are regularly re-analyzed; especially those that continue to follow the patients in the studies. In these analyses overall, mammography reduced breast cancer mortality by at least 20 to 30 percent. Just one year ago, a study published in the New England Journal of Medicine analyzed the relative roles of screening mammography and treatment advances in the steady decline in breast cancer mortality since 1990. It demonstrated that mammography is responsible for 45 percent of the additional lives saved, while treatment advances account for 55 percent. The Society's guidelines for the early detection of breast cancer are: +Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health. Clinical breast exams (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over. +Women should report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s. +Women at increased risk (e.g.: family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g.: breast ultrasound or MRI), or having more frequent exams. For more information on access to care, and to find free or low cost mammograms, call the American Cancer Society at 800-ACS-2345 or visit www.cancer.org.
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