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THURSDAY, Nov. 29 (HealthDay News) -- A mammogram isn't the easiest medical exam to endure, sometimes painful and often embarrassing to the woman.
And that's thought to be one potential reason why mammography rates have declined in women over age 40, after decades of steady increase, according to researchers at the U.S. National Cancer Institute.
That decrease has alarmed cancer experts, who believe the X-ray exam is the best way to detect breast cancer early.
"Mammograms are not perfect tests, but they currently are the most effective test available," said Dr. Michael Naughton, a breast cancer oncologist at the Washington University School of Medicine's Siteman Cancer Center in St. Louis.
"I think the best evidence that mammograms save lives is the falling mortality rate since we've been using them for early detection," added Naughton, who's also a member of the American Society of Clinical Oncology.
The death rate for breast cancer began to fall in 1989, dropping by about 1.6 percent each year through 1995, according to the American Cancer Society. Between 1995 and 1998, the drop in rates picked up even more speed, declining about 3.4 percent each year.
Overall, between 1990 and 2002, death rates from breast cancer declined an average of 2.3 percent annually for all women, with larger reductions in women younger than 50, according to cancer society statistics.
The drop in breast cancer rates coincided with an increase in the use of mammography to detect tumors in the breast.
Between 1987 and 2000, the use of mammography dramatically increased in women over the age of 40, from 39.1 percent to 70.1 percent, according to the National Cancer Institute. Rates stabilized between 2000 and 2003, but, by 2005, rates were 4 percent lower than they were in 2000 -- 66 percent versus 70 percent.
Doctors are concerned that if the use of mammography continues to decline, the success they've had in saving lives from breast cancer will begin to falter.
Breast cancer mortality has continued to decline, even as mammogram rates stabilized and then fell, but Naughton believes there would be a lag before the reduced use of mammograms would begin to show itself in more cancer deaths.
"If we stopped doing mammograms today, we wouldn't see an increase in the mortality rate for four or five years," Naughton said. "But survival is linked to early detection. The earlier the stage of cancer when we find it, the more likely the woman will survive."
Mammograms typically involve two low-dose X-rays of each breast. The technician taking the X-rays places each breast between two panels, pressing to get a clear picture and causing discomfort in some women.
Mammograms make it possible to detect tumors that can't be felt. The screening also can find microcalcifications, or tiny deposits of calcium, that sometimes indicate the presence of breast cancer, according to the National Cancer Institute.
The U.S. government recommends that women begin regular mammography screenings at age 40, receiving an examination every one to two years. Women at higher-than-average risk due to family history or other factors should talk with their doctor about whether they should begin regular screenings earlier than 40.
No studies have yet shown why the mammography rate has declined, but cancer experts have their guesses.
America's health-care system is one culprit in the eyes of Dr. Aman Buzdar, a professor of medicine and deputy chairman of the department of breast medical oncology at the University of Texas M.D. Anderson Cancer Center, in Houston.
With dozens of health insurance plans offering different benefits, women can become confused about when they need to receive a mammogram, Buzdar said.
"In the countries where the mammogram rate is high, we find there is a single payer who notifies patients that they are due for their mammogram," he said.
That leads to another possibility -- that women simply forget about undergoing the screening.
"A number of patients, it just falls off their radar," Buzdar said.
Discomfort and embarrassment also are believed to play a part, both Buzdar and Naughton said. "Physical discomfort is definitely a discouraging factor," Naughton said.
Finally, women might be avoiding the screening, because they just don't want to hear they might have cancer.
"They just don't want to hear the news, even if it's better to hear it when they can't feel anything," Buzdar said. "But detecting the disease early is in your best interest. You can successfully beat the cancer if it's detected early, versus just hoping that there's nothing there."
SOURCES: Michael Naughton, breast cancer oncologist at the Siteman Cancer Center of the Washington University School of Medicine, St. Louis, and assistant professor of medicine in the university's division of medical oncology, and a member of the American Society of Clinical Oncology; Aman Buzdar, M.D., professor of medicine and deputy chairman of the department of breast medical oncology at the University of Texas M.D. Anderson Cancer Center, Houston; National Cancer Institute; American Cancer Society
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