Worship in Pink
The chance of winning the Powerball lottery is 1 in 175 million. Yet people play. A LOT of them play. We take our chances.
The chance of being struck by lightning in a lifetime is 1 in 14,000. Yet people walk in the rain, attend sporting events in the rain, and go storm watching. We take our chances.
The chance of dying in a motor vehicle accident is 1 in 88. Yet people drive, even some without seat belts or too fast (not something that is advisable). Sometimes good or bad, we take our chances.
For women, the chance of being diagnosed with breast cancer is 1 in 8. Over 41,000 people in the United States alone die of breast cancer yearly. Yet many women do not get screened with exams or mammograms.
My name is Rachel Sanborn. I am a medical oncologist at Providence Cancer Institute. The term “medical oncologist” means that I am the type of doctor who helps coordinate chemotherapy, immune therapy, and other systemic treatments for cancer. My specific subspecialty is in treating lung cancer and working with early phase clinical trials for people with advanced cancers. Basically, as a group, we recognize as specialists in this field that we are the doctors no one ever wants to have to see.
In times past, there were no methods for treating cancers, let alone screening for them. Cancers were diagnosed when very advanced, and almost universally became a death sentence. History can become folklore, folklore can become pattern, and pattern can lead to sometimes unshakeable perceptions.
Times have changed. Science has changed. Treatment options for cancer have changed dramatically over the last decades. Many cancers, if caught early, can now be cured. Even when not curable, most people can live longer and with better quality of life having their cancers treated.
The term “cancer screening” means attempting to identify a cancer when it is still small, when potentially more easily treatable, and when the chance of cure is greater. The goal of cancer screening then is to find a cancer at an earlier “stage”, meaning before the cancer has had a chance to become large, or to send seeds in the body to other more distant locations. Smaller tumors in general can be more easily removed, and have had less time to send those seeds in the body to spread.
The first paper describing the use of xrays of womens’ breasts to identify breast cancers at an earlier stage was published in 1959, and thus mammography came to be. Today, mammography uses ultra-low-dose radiation to generate very high-quality and sophisticated images of breast tissue, with the images looking for small calcium deposits where they do not belong, pointing out areas of potential problem.
The fact is, most abnormalities identified on mammography are benign, meaning, not cancer. Cysts, scars, and other non-cancerous findings may show up on a mammogram, which may require further evaluation and testing, such as ultrasounds or biopsies, in order to make sure. This is the case with any screening test; in looking for the real problems, other abnormalities may be found, but you need the test to be sensitive enough that real problems are not missed in the process. In general overall concept, and to use an analogy we are used to hearing in church, with a screening test like a mammogram we will still need to separate the wheat from the chaff. But we don’t want too much wheat to escape.
The United States Preventive Services Task Force has found that mammograms have reduced mortality, the chances of dying, from breast cancer. The amount of benefit from mammograms can vary by a number of factors, such as age, family history, and a woman’s general health status. This has led to different organizations making slightly different recommendations for timing of having mammograms, but the overall message is that mammograms are important, and for a woman it is important to talk with their doctor about recommended timing of mammograms and breast cancer screening. For a relatively quick test that has been around for almost 60 years, there are some estimates that 1/3 of eligible women don’t get tested. In some groups, this number can be even higher.
This is particularly important when we look at the fact that in the US, African-American women are disproportionately affected by breast cancer, meaning that breast cancers are diagnosed more often at more advanced stages, with more aggressive cancers, and African-American women have higher mortality rates with breast cancer.
Why do women not get screened? The answers to this question can be many and complex. There is fear: the test might hurt, it might be embarrassing. There is nihilism: finding the cancer won’t change the outcome, I don’t want to know. There is lack of awareness. There is concern for cost.
The last part of that issue is a challenge in every society worldwide, and our relatively affluent country is no exception. Many people in the US are without health care coverage, or fit into a category we call “underinsured”, which can make the out of pocket costs for mammograms and other basic health screening prohibitive.
For the last part, at least, there is good news. There are services that can provide financial help or even free mammograms for women without adequate insurance coverage. There are people and organizations willing to help. Having a mammogram does not need to be financially out of reach for a woman who may be recommended to be screened. In the coffee hour today, there will be information provided specifically about resources in Oregon and Washington to help cover the cost of mammography for women who need it.
Chances of surviving 5 years with stage I breast cancer, the earliest stage, is close to 100%. Chances of surviving 5 years with stage IV breast cancer (cancer that has spread to other areas of the body) is about 22%.
If a woman has a mammogram, there is a chance something will be found. There is a chance she will need more evaluation. There is a chance she will even need to see a doctor like me. There is a chance the news will be bad. There is a (pretty good) chance that in most situations, she may still be able to be cured with treating the cancer, and will be able to live the rest of her life cancer-free. It may be scary, it may not be easy.
How do YOU want to take your chance?