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It's in you hands Mammograms are still best weapon we have against breast cancer, but fewer women are getting the life-saving screening

In October, pink is everywhere. From wine to doughnuts, from Hershey's Kisses to kitchen appliances, products decorated with pink ribbons raise awareness about breast cancer, which will strike one in eight women.

But despite all of the increased attention on a national problem, a study published last year by Dr. Nancy Breen of the National Cancer Institute has revealed a worrisome trend -- fewer women are getting mammograms, the screening that could save their lives.

By 2000, Breen and her co-authors found that 70 percent of women 40 and older got annual mammograms. By 2005, that number had fallen to 66 percent.

The situation may be even bleaker locally. A study done for the Western New York Affiliate of Susan G. Komen for the Cure found that only 62.9 percent of women over 40 reported they had had a mammogram in the previous 12 months.

"I think the decrease in mammography rates is a very worrisome trend," said Dr. Ermelinda Bonaccio, director of mammography in the Department of Diagnostic Imaging at Roswell Park Cancer Institute. "Over the past several years, mortality for breast cancer has been decreasing. Part of it is that our treatment has gotten better, but part of it is, most people agree, mammography. With a decrease in mammography rates, we could lose that edge."

Bonaccio's department at Roswell doesn't do screenings for the general public, but in her years of experience in the field, she's talked to enough women who've avoided mammograms to have an idea of why they do it.

"The most common reason I hear is fear," she said. "They are just so scared of the results -- that there might be something there -- that they just can't bring themselves to go and do it."

The second reason is apprehension about discomfort during the brief period when the breast is compressed.

Nicole Crawford, organizational development supervisor for Windsong Radiology Group, which has been recognized by a trade publication as the busiest imaging center in the country, said, "Compression is critical to the quality of the exam." Even though each breast must be repositioned and scanned several times for a mammogram, she said the total amount of compression time is usually no more than 90 seconds.

"It reminds me of when you're pregnant and everyone tells you the horror stories," said Bonaccio. "People love to talk about how painful and how terrible it is, which I think will sometimes dissuade some women. And for a small percentage of women [a mammogram] is a very uncomfortable exam, but I think it needs to be balanced against the benefits."

>The benefits

How's this for a benefit? Ida Goeckel of Kenmore says a mammogram saved her life.

Goeckel had a mammogram scheduled for February 2003, but it was delayed and rescheduled for July, when the 5-centimeter mass was spotted. Because of its location, "It would not have been a lump I could have found on my own," Goeckel said. "I would have never found it if not for the mammogram. And if I had gone for my mammogram in February when I was originally scheduled, it would have been too early to detect it and they never would have found it until February 2004. Who knows what advanced stage it would have been in by then?"

Goeckel, who will hold her sixth annual Female Musicians Fighting Breast Cancer benefit for the Roswell Park Breast Care Clinic and Resource Center this Sunday, is vigilant about having mammograms herself and pushing her friends to do the same. But she hasn't had much success with her maternal aunt, who has had only one mammogram in her life -- the one that diagnosed her breast cancer. Her aunt, now 76, had a mastectomy and "doesn't see the point" of having further mammograms, said Goeckel.

"A lot of older women don't follow up on routine tests, including colonoscopies, mammograms and Pap smears," said Goeckel. "They figure if they don't go, they won't hear the bad news."

But they also won't hear the good news.

Carolyn Koelmel of Hamburg, a member of the board of directors of the Western New York Affiliate of Susan G. Komen for the Cure, compares the annual mammogram to "getting ready for a big exam at school -- when it's over, you get to leave and it's like the weight of the world is off your shoulders."

Koelmel found a lump in one breast and her gynecologist suggested she go for her annual mammogram early. The scan found some "inconclusive" spots, but they were in the other breast.

Her immediate reaction was to delay further tests, Koelmel said. "But the radiologist strongly urged me to get it looked at, and my children insisted."

Two of the spots in her other breast were cancer.

In expressing interest in their mother's health, the children were simply following in Koelmel's footsteps. Before her mother's death in 2006, Koelmel took her for annual mammograms. "She wouldn't want to go, and I'd say, 'No, we're going together.' " The two made a day of it -- "We'd have the mammograms, then go to lunch afterward, and I think she appreciated that."
Marcia Heaney, a health educator who is the education chair and past president of the Breast Cancer Network of Western New York and serves on the state board of breast cancer survivors, was being treated for a pulmonary embolism when "a very alert radiologist" detected something and sent her for a mammogram in between her regular yearly mammograms.

"Seven years later, I'm fine," she said, and now, "my passion is to make people educated consumers."

"Mammograms are the best diagnostic tool we have right now for screening people. Until we come up with something better, women need to have mammograms," she said.

>The cost

Some health plans offer low co-pays, and at least one, Independent Health, plans to offer free coverage for many preventive health tests, including mammograms. But people without health insurance, or with a plan that kicks in only after the patient has paid thousands of their own money, may be deterred by the cost of mammograms.

Partners for Prevention Cancer Screening Services of Erie County is funded by the state health department, with local sponsorship from the Erie County Department of Health and the American Cancer Society. It covers screening tests for colon cancer, cervical cancer and breast cancer, including annual mammograms for women age 40 and over, or high-risk women under 40.

"Just about all all of our people are working," said Michelle Wysocki, program director of Partners for Prevention. "They are the people who are struggling, working lower-paid jobs or two part-time jobs, or they've gotten laid off from their jobs."

Anyone who may qualify for the free cancer screening should call Partners for Prevention at 886-9201. After a phone interview, the agency sets up its clients with a free appointment at one of the more than 100 medical providers, including "all the hospitals in Erie County, a number of private ob-gyn offices and almost every private radiology office," said Wysocki.

But the coverage doesn't stop there. If a screening mammogram finds a problem, Partners for Prevention can pay for follow-up care, ranging from biopsy to cancer treatments.

But a woman can't fight cancer if she doesn't know she has it.

"Mammography is really the one test that has been shown to decrease mortality -- the actual death rate from breast cancer -- from 25 to 30 percent," said Bonaccio. Mammograms aren't perfect, "but they are the very best tool we have."

e-mail: aneville@buffnews.com

Female Musicians Fighting Breast Cancer will begin at 1:30 p.m. Sunday at Macaroon's Nite Club, 576 Dick Road, Depew. Lana and Hund, Noa Bursie, Cold Sweat and the headliner Hit n Run will play, and prizes and a silent auction will be held. Tickets, sold at the door, cost $10.

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