Due to a number of high-profile spokespeople and a highly vocal survivor population, breast cancer has become one of the most successful public education campaigns in the United States. Katie Marie Harmon, Miss America 2002, recently named the support of terminal breast cancer patients as her speaking platform. Lisa Leslie, MVP of the WNBA, recently joined the WNBA’s own initiative for breast cancer awareness as its national spokesperson. At the center of this public relations victory is a single
technological procedure: the mammogram.
About one third of breast cancers are detected by mammography alone. Another third are detected by a combination of physical exams and mammography. In the last two years, over 70 percent of women aged 40 and over have received a mammogram, making it one of the most widespread diagnostic procedures in the United States. Over the last ten years, the death rates of breast cancer in the United States have declined considerably, in large part due to the earlier detection of the cancer which mammography made possible.
"Early detection of cancer saves lives and we continue to recommend mammography for women in their 40s and older," said Andrew von Eschenbach, M.D., director of the National Cancer Institute. "While we seek improved methods of diagnosis and treatment of breast cancer, today mammography remains an important part of our effort to save lives through early detection. Health and Human Services Secretary Tommy G. Thompson concurs: "While developing technology certainly holds the promise for new detection and treatment methods, mammography remains a strong and important tool in the early detection of breast cancer. The early detection of breast cancer can save lives."
According to the World Health Organization, more than 1.2 million people will develop breast cancer this year. The American Cancer Society has predicted that roughly 192,200 women in the United States will develop invasive breast cancer over the coming year; and another 46,400 women would develop noninvasive breast cancer (confined to the milk ducts). Breast cancer is the second leading cause of cancer deaths in women today, after lung cancer, and the most common cancer among women, ultimately affecting one in eight. Among women over fifty, who represent 77 percent of all breast cancer patients, annual mammographs have been shown to reduce the death rates of breast cancer by half.
The first mammography device was developed in 1966. Before 1966, mammographic images were produced by a simple X-ray machine. This original machine was little more than an X-ray mounted on a tripod, which was better able to focus on the chest cavity and the tissue of the breast. Over the next decade, the technology of mammography continued to improve. A second generation of the mammograph machine, produced in 1980, reduced the necessary exposure time significantly, which made the procedure much easier and less intimidating for patients. The machine used more advanced film and was able to produce images with greater resolution, accuracy, and detail.
In 1994, the Food and Drug Administration (FDA) first undertook the regulation of mammography in the United States. The Mammography Quality Standards Act, effective Oct. 1, 1994, requires all mammography facilities in the U.S. to be accredited and federally certified. It also mandated that all facilities pass annual inspections. Now, the FDA is the federal body responsible for all regulation of mammography and mammography equipment.
In 1999, the field of mammography was the target of a large number of lawsuits, many of which were filed by women under the impression that the mammogram was a foolproof diagnostic procedure. In reality, mammography can detect at least 90 percent of all tumors among older women, and at least 75 percent of all tumors among younger women, a remarkable success rate but not a flawless one. Dr. Marc Homer, a professor of radiology at the Tufts University School of Medicine, was quoted in the New York Times as saying, "The public perception is that the mammogram is a test that is 100 percent accurate." Ironically enough, many of these destructive misconceptions may be due to exactly the public education campaign which has been so successful in its promotion of mammograms. In the 1980s, for example, the American Cancer Society issued promotional materials stating that "breast cancer has virtually nowhere to hide."
Many medical professionals have advocated that the images be verified by more than one physician. In 2000, the development of a new technology made it far easier for physicians to share and verify these images. At that time, the FDA approved a device known as the Senographe 2000D, which produces digital images rather than more conventional x-rays. Because the images are computerized, it is also possible for the physician to magnify the view of specific areas of the breast, and to correct for over- and underexposure. This new device uses 20 percent less radiation, on average, than earlier techniques, takes less than half the time of standard mammography, and produces images which are much easier to store and transmit than standard x-ray images. (To see a complete discussion of the advantages of digital mammography, as well as two contrasting examples of standard mammography and digital mammography, go to the following website: http://www.cancernews.com/category.asp?cat=3&aid=210.)