Breast & Cervical Cancer
Why This Measure?
American women have a one-in-eight risk of developing breast cancer over an average lifetime. Our lead indicator focuses on mammography because it has been shown to reduce deaths by 26% for women aged 50 and over (althouth it does not appear to reduce breast cancer mortality for premenopausal women) (Personal Health: A Multicultural Approach, 1995). Small tumors are easier to detect by x-ray against the higher content of fatty breast tissue typical of older women, as opposed to dense, fibrous breasts. With early detection, treatment can be more successful. The indicator is also a good gauge of the overall effectiveness of the health care delivery system.
Selected Montana Women Getting Breast Exam and Mammograms
Source Montana BRFSS 1998
Missoula County Population Estimates (July 1998) By Age and Gender (useful in translating percentages and rates into actual numbers in certain age categories, or vice versa) Missoula County Population
Trend Suspect Better Data Rating Available Reliable Relevant
In terms of mammograms, we appear to be doing well. We have surpassed the Healthy People 2000 goal of 60%. But that still leaves nearly three in 10 women over 50 whom we still need to reach. Current mammogram guidelines recommend that women over 20 do self-exams every month, receive clinical breast exams between 20-40 every three years, receive an initial mammogram at 35, and annual mammograms beginning at 40. 23% of breast cancer occurs in women under age 50. Mammograms miss about 15% of breast cancers. (Dr. Judy Schmidt) Of Missoula women over 50, 58% got a mammogram within the past year during1996.
Source: Montana Central Tumor Registry, MDPHHS, Vital Statistics
Nine out of 10 women discover tumors through regular breast self-exam, and 80% of those tumors are benign (The Impact of Cancer on Montana, Part 1: Cancer Fact Book, 1995). However, tumors detected in this manner are usually larger and in a later stage of growth.
In six Missoula focus groups, reasons for not getting mammograms included:
- Lack of financial resources.
- Disbelief of media messages.
- Preference for female health care providers.
- Great fear of cancer.
- Strong influence of female peers and family.
- "Fear factors," embarrassment, pain, and discomfort.
(Six Focus Groups, PHC, 1995)
Risk factors associated with family history account for about 5% of breast cancer cases. (Dr. Judy Schmidt) Other factors correlated with some increased risk include early menarche, late menopause, never bearing children or late age at first birth (Cancer Facts and Figures, American Cancer Society, 1995). The levels and types of fat common in the American diet, moderate alcohol consumption, and obesity have also been associated with higher breast cancer rates, as well as lack of exercise (4 hours per week are necessary) (The Impact of Cancer on Montana, Part I: Cancer Fact Book, 1995). Additionally, women with lower incomes (less than $20,000 annual household income) are less likely to have had a breast physical exam than women with higher incomes (MT BRFSS, 1996).
The Montana Breast and Cervical Health Program has produced a brochure called "side-by-side" that summarizes services of the MBCHP, the American Cancer Society, and the Montana Komen Race for the Cure, as well as more websites.
The Montana Breast and Cervical Health Program has an administrative site in Missoula offering yearly mammograms, clinical breast exams, education, and regular Pap tests to uninsured or underinsured women ages 50 through 64. Income to qualify is up to and including 200% of poverty (a woman in a one person household can earn up to $7.92 per hour in a full-time job andqualify). The Missoula site serves Missoula, Sanders, and Ravalli counties. Enrollment of providers is currently being done, so there should be providers available in each county to serve qualified women. Daphne Evans is the coordinator in the Missoula area, located at Partnership Health Center.
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