By Leonard Lichtenfeld, MD
Deputy Chief Medical Officer
American Cancer Society
It's National Breast Cancer Awareness Month, and that means we will see a lot of pink and an abundance of breast cancer messages for the next few weeks. One message that women will hear over and over again this month is, “get a mammogram.” I find myself asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms, or is there more to the story? The answer is an unequivocal “yes”—there is much more to the story.
There's no doubt that breast cancer awareness month has been enormously successful in bringing attention to breast cancer and creating public focus on a very important issue for women. And why shouldn't we highlight mammography's role? When I was a young oncologist, I dreamed of a day when we would have not only better treatments for cancer, but tests that found cancers early. Then along came some of those tests, including mammography, prostate cancer screening, and science-based evidence that colorectal cancer screening saved lives.
History, however, has had some interesting turns and twists along the way. We now say that men should be informed of the benefits and harms of prostate cancer screening. Colorectal cancer screening has decreased deaths, but we are short of the mark on getting people screened. And mammography has suffered relatively recent slings and arrows as some experts have questioned whether our beliefs and assumptions about mammography's ability to save lives are correct.
The American Cancer Society recommends that women should have an annual mammogram every year beginning at age 40, along with regular clinical breast exams starting at age 20. The Society stands by the evidence that mammograms save lives and have helped significantly reduce deaths from breast cancer.
However, with all the breast cancer discussions this month, what we don't talk about is that too many women in this country still don't have access to quality mammography or to quality treatment. Many women simply can't afford to get screened or get treatment, and the programs that are designed to address that lapse are considerably underfunded. In my home state of Georgia, only one in five women in need has access to a program that can provide that basic part of their medical care. Or they work all day all week and can't get to a mammogram facility on nights or the weekends because those facilities aren't open then. These women may get the message, but they can't get the care.
I'm proud to point to the American Cancer Society's Community Health Advocates Implementing Nationwide Grants for Empowerment and Equity (CHANGE) program as a small but meaningful step to close this gap. Funded by several supporters interested in helping individuals prevent cancer and find cancer early, the program provides education and screenings to individuals who are uninsured or under-insured and don't have access to care. Over the past three years, CHANGE grants have educated more than 607,000 women and men about breast, cervical and colorectal cancers and provided more than 140,000 cancer screenings at low or no cost. CHANGE also addresses cultural and linguistic barriers that interfere with access to screening, and the restricted office hours by supporting partners in extending hours to nights and weekends and meeting individuals where they are with mobile screening units.
CHANGE is an important step, but we can, and simply must, do more.
Too many women, once diagnosed with breast cancer, either have significant delays in treatment or don't get any treatment at all. My colleague, Dr. Otis Brawley, chief medical officer for the American Cancer Society, published research several years ago that pointed out that in Atlanta, five percent of women diagnosed with breast cancer received no treatment for their disease. How can we accept the fact that women with a treatable cancer can't get treatment or will receive less than adequate care?
How important is this disparity? Back in the 1970s, there was no difference in breast cancer mortality between white and black women. Now there is: white women have increasingly lower mortality rates from breast cancer compared to black women. This gap only developed once mammography and more effective treatments became available. There is still a large segment of our population that isn’t realizing the life-saving potential of these breakthroughs, which are now generally accepted standards of care.
The medical reality is that the gains we have made in breast cancer are likely due to a number of factors, of which mammography is just one. Over the past 20 years, we have been fortunate to have a number of new approaches to breast cancer, including targeted therapies. Those new treatments continue to make significant contributions to reducing deaths from this disease.
Breast cancer awareness is playing an important role in the fight against the disease. It wasn’t long ago that no one talked about breast cancer in public. Today, thanks in large part to awareness efforts, we discuss breast cancer publicly, and there is a lot of information available. With awareness has come better care and fewer deaths. But awareness about mammography alone is not awareness about breast cancer.
My hope for National Breast Cancer Awareness Month is that there will be more attention paid to breast cancer risk assessment and prevention. I hope that we will put at least some of our efforts this month toward raising awareness about the fact that not everyone is benefitting equally from the remarkable progress in breast cancer early detection and treatment.
Let's celebrate the successes that awareness has helped bring about. At the same time, let's acknowledge our inability to get all women in this country access to fundamental care we know improves outcomes for breast cancer. Let's not forget that there are many women whose disease has recurred or for whom mammography did not save their lives (a 20 percent drop in risk with mammography still means 80 out of 100 deaths happen).
Let us also never forget those whose disease was a greater foe than our best abilities could overcome. And let us vow that we will redouble our efforts to ensure that every woman has access to the treatment and care we have to prevent, detect and treat breast cancer effectively. Anything short of that is woefully incomplete.
Dr. Len Lichtenfeld is Deputy Chief Medical Officer of the American Cancer Society